- SCAN Health Plan eyes expansion into Nevada, Arizona for 2022 (fiercehealthcare.com)
Medicare Advantage insurer SCAN Health Plan will expand its coverage options into Arizona and Nevada for the 2022 plan year, the company announced....The growth marks the first time that SCAN has expanded beyond California and into two new markets at the same time, according to the announcement. The insurer boasts 220,000 members in the Golden State...SCAN Health Plan (Nevada) will offer plans in Clark County, Nevada and SCAN Desert Health Plan (Arizona) will provide coverage in Maricopa, Pima and Pinal counties...READ MORE
- Study: Medicare spent billions more on generics than Costco due to distribution inefficiency (fiercehealthcare.com)
Medicare Part D spent $2.6 billion more in 2018 on generic drugs compared to Costco, likely due to the inefficient distribution system...The study published...in the Journal of the American Medical Association focuses on how intermediaries in the generic drug supply chain may be driving up costs for Medicare. In 2018, 88% of Medicare Part D prescriptions were for generic drugs, the study said...“Our analysis highlighted the inefficiencies the current system introduces through its complex and opaque system of intermediaries, which Costco largely bypasses,”...READ MORE
- Proposed state employee health insurance cuts leads to state workers pushback (thenevadaindependent.com)
Amid a slew of cuts attempting to mitigate projected budget shortfalls in a state largely dependent on tourism and gaming for revenue, state employees are protesting proposed changes that would reduce health care coverage options provided by the state...The proposed cuts in the Nevada Public Employees' Benefits Program budget would reduce life insurance benefits from $25,000 for an active employee to $15,000 and from $12,500 for a retiree to $7,500, eliminate long-term disability insurance and lower Medicare Health Reimbursement Arrangement contributions from $13 to $11 a month per year of service. Though Gov. Steve Sisolak in his State of the State address touted only a 2 percent state budget cut, programs such as PEBP are feeling the cuts more deeply than others...READ MORE
- Fierce Pharma Politics—Canada restricts U.S. drug exports after Trump executive order (fiercepharma.com)
After President Donald Trump issued a range of executive orders targeting high U.S. drug prices in recent months, America's neighbors to the north are responding...Following warnings that mass exports could cause domestic drug shortages, Canadian officials blocked the shipment of meds to the U.S. if the exports would “cause or worsen” a shortage...The Canadian restriction went into effect on Friday, before the United States’ own rule to allow cheaper imports from its neighbor country as a way to lower prices...Moving forward, companies in Canada will be “required to provide information to assess existing or potential shortages, when requested, and within 24 hours if there is a serious or imminent health risk,” Health Minister Patty Hajdu said...READ MORE
- Part 1: Medicare Part B Provider Status for Pharmacists – Episode 1 (drugtopics.com)Part 2: Medicare Part B Provider Status for Pharmacists (drugtopics.com)
In an interview with Drug Topics®, Ken Perez, MBA, vice president of Healthcare Policy and Government Affairs at Omnicell, explained the crucial points of Medicare Part B provider status for pharmacists, which would allow pharmacists in underserved communities to be reimbursed for certain primary care services that they already provide in commercially ensured populations...READ MORE
- Pfizer victory in Vyndaqel copay lawsuit could kneecap the government’s only control on prices, lawyer warns (fiercepharma.com)
After coughing up nearly $24 million in a federal settlement over donations to patient charities, Pfizer went on the offensive last summer and took the U.S.' anti-kickback policies to task. Late last month, the drug giant got its day in court...The company, angling to help Medicare patients pay for its costly heart drugs Vyndaqel and Vyndamax, recently challenged U.S. copay and kickback policies in New York federal court...a Pfizer win...could spur drug pricing fallout across the industry...Pfizer last June sued HHS in a bid to assist patients with their Medicare copays for two costly new medicines. U.S. kickback laws currently forbid drugmakers from helping patients with those costs...Pfizer is battling for the go-ahead on two programs. The first would allow the company to offer copay support directly to Medicare patients on its tafamidis meds Vyndaqel and Vyndamax, which run for $225,000 a year before rebates. The second would allow it to fund an independent charity to help with copays...READ MORE
- CMS finalizes rule aimed at cutting lag time of Medicare coverage for breakthrough devices (fiercehealthcare.com)
The Trump administration finalized a rule...that will grant faster Medicare coverage decisions on new breakthrough medical devices...The rule will tackle the lag time between when a new device is approved or cleared by the Food and Drug Administration and when it gets covered by Medicare, a time the administration refers to as the “valley of death” for innovative products, officials have said. The rule creates an accelerated Medicare coverage pathway for "breakthrough" devices, or those which the FDA approves on an expedited basis...READ MORE
- AAM report: Medicare plans lag in adopting new generics (drugstorenews.com)New Generics Are Less Available in Medicare Than Commercial Plans (accessiblemeds.org)
The Association for Accessible Medicines’ latest report found that Medicare Part D plans are slow to add new generics to their formularies and often place them on nongeneric pricing tiers...Medicare Part D plans are slower than commercial plans to adopt new generics, and even when adopted, the generics are less likely to be part of a generic cost tier. That’s according to a new report from the Association for Accessible Medicines that examines the speed of first generics entering formulary coverage for both Medicare Part D plans and commercial plans...READ MORE
- Democrats eye Medicare negotiations to lower drug prices (fiercehealthcare.com)
Democrats...are united behind an idea that Republican lawmakers and major drugmakers fiercely oppose: empowering the Department of Health and Human Services to negotiate the prices of brand-name drugs covered by Medicare...Democrats hope to authorize Medicare negotiations on payments for at least some of the most expensive brand-name drugs and to base those prices on the drugs’ clinical benefits...READ MORE
- Drugmakers sue HHS over 340B advisory opinion in feud over contract pharmacy access (fiercehealthcare.com)
The lawsuits, filed...in different federal courts, seek to get rid of an advisory opinion filed by the Department of Health and Human Services’ general counsel that says drug companies must offer 340B drugs to contract pharmacies, which are third-party entities that dispense drugs on behalf of hospitals participating in the program...The drug companies argue that the advisory opinion contracts (contradics) the statute for the 340B program, which requires manufacturers to offer discounted products to safety net hospitals and other providers in exchange for participation in Medicare and Medicaid...“The statute, on its face, does not require manufacturers to recognize any contract pharmacies, much less unlimited contract pharmacies,” the legal filing from AstraZeneca said...READ MORE