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The United States government could save billions of healthcare dollars if it purchased generic drugs at the prices offered by Mark Cuban’s new online pharmacy that was launched this year...In a comparison between Medicare’s spending in 2020 and the prices of Cuban’s Cost Plus Drug Company, researchers found that Medicare could have saved $3.6 billion, according to new research from Brigham and Women’s Hospital and Harvard Medical School published...in the journal Annals of Internal Medicine...READ MORE

The econowonks at the Centers for Medicare & Medicaid Services recently released the latest projections for U.S. spending on healthcare. These data provide our first official look at post-pandemic U.S. healthcare spending...As you will see below, outpatient prescription drugs dispensed by retail and mail pharmacies are projected to remain a small share (8.4%) of total U.S. healthcare spending. What’s more, taxpayers—via Medicare and Medicaid—will continue to crowd out the private insurance market. One bright spot: consumers will account for an ever-smaller share of drug spending...READ MORE

A new ranking of the 10 most cost-efficient hospitals in the U.S. reveals that if all hospitals matched their performance, $8 billion could be saved in Medicare dollars...The ranking, conducted by healthcare think tank Lown Institute , was based on Medicare data from 2016 through 2018 on more than 3,000 hospitals focusing on what they billed and how many patients died. For the analysis, it adjusted both mortality rates and cost based on patient risk...Here are the 10 most cost-efficient hospitals in the U.S., according to the Lown Institute:

Pinnacle Hospital (Crown Point, Indiana)

Saint Mary’s Regional Medical Center (Reno, Nevada)

Mercy Medical Center Dubuque (Dubuque, Iowa)

Encino Hospital Medical Center (Encino, California)

Park Ridge Health (Hendersonville, North Carolina)

Oroville Hospital (Oroville, California)

Saint Michael’s Medical Center (Newark, New Jersey)

UnityPoint Health – Meriter (Madison, Wisconsin)

East Liverpool City Hospital (East Liverpool, Ohio)

Maple Grove Hospital (Maple Grove, Minnesota)

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The Department of Health and Human Services wants to test models that would pay drugs based on their clinical value as part of a new plan to tackle high prices...The plan...lays out several administrative tools the agency plans to take to address high prices. It also calls on Congress to adopt several reforms such as giving Medicare price negotiation authority and cap Part D catastrophic spending...“By promoting negotiation, competition, and innovation in the health care industry, we will ensure cost fairness and protect access to care,” HHS Secretary Xavier Becerra said in a statement...READ MORE

List prices of branded drugs in the U.S. rose by an average of nearly 5% last year, according to a report released...by Iqvia, a consultancy and research services provider. After accounting for the rebates and discounts pharmaceutical companies often pay insurers, however, the average increase was 1%, the fifth year in a row that net price growth has tracked below general inflation...Rebates and discounts on drugs don't necessarily translate to lower out-of-pocket costs for patients, and some, such as people covered by Medicare Part D or on high-deductible insurance plans, are more vulnerable to rising list prices, often referred to as a drug's wholesale acquisition cost...READ MORE

The Biden administration has officially pulled a controversial model that would have tied prices for drugs reimbursed under Part B to prices paid by countries overseas...The Centers for Medicare & Medicaid Services issued a final rule last week that pulls the demonstration approved at the tail end of the Trump administration. Providers had slammed the Most Favored Nation model due to concerns over reimbursement...CMS said in the final rule published on Dec. 29 that the model sparked four lawsuits from the drug industry, which resulted in a legal stay delaying it from going into effect...READ MORE

UnitedHealthcare will adjust claims for COVID-19 vaccines in response to providers who said they were paid sub-Medicare rates to administer the shots...the nation's largest insurer said it has been reimbursing for COVID-19 vaccines at the $40 per administration Medicare rate since July 1 but that it will adjust claims that were underpaid between March 15 and June 30 to that same rate...A number of physicians, particularly pediatricians, have called out UHC for underpaying them to administer COVID-19 vaccines...George Rogu, M.D., a pediatrician and CEO of Commack, New York-based RBK Pediatricians, said physicians of all kinds faced significant costs in setting up vaccine programs...READ MORE

The petition, going to Senator Catherine Cortez Masto and Jacky Rosen, pleads Congress to take action...Both Senators have cosponsored legislation to cap out-of-pocket insulin costs at $35...Senators Cortez Masto and Rosen also support giving Medicare more power to negotiate drug prices, and they are pushing for penalties that would keep drug companies from increasing prices faster than the rate of inflation..."I've seen it in my own family with my grandmother who had to make the decision whether she could put food on the table or pay for her drugs," said Senator Cortez Masto. "She was living off of Social Security after she retired. No senior, nobody should have to go through that."...READ MORE

Today, I examine how smaller pharmacies will participate as preferred cost sharing pharmacies via the pharmacy services administrative organizations that represent them in negotiations with plans...the largest PSAOs are increasingly rejecting preferred networks. Below we provide details about the PSAOs owned by the three major wholesalers—AmerisourceBergen, Cardinal Health, and McKesson—along with information about AlignRx, the largest independent PSAO. There are some notable differences in strategy, as you will see from our handy scorecard below...Smaller pharmacies’ rejection of Part D preferred networks shows that they are figuring out how to survive a highly challenging retail environment. Perhaps Part D is just a flesh wound?...READ MORE

When posed with the decades-old question of how drug price reform would affect their operations in the U.S., pharma execs have a ready-made response: Reducing drug prices would hinder innovation...While Eli Lilly CEO David Ricks falls in line with the mantra, he bolsters his case with a cautionary example, pointing to Europe and the effect government pricing regulations have had there...“In the 80s and 90s, this was a European industry,” Ricks said in an interview. “Eighty percent of global R&D was happening on the European continent and today it’s less than 20. Where’s that going? It’s gone to America.”...READ MORE