- Trump to unveil international pricing index, rebate crackdown rules: reports (fiercepharma.com)Trump Announces New Drug Pricing Model Is Set for January 2021 (drugtopics.com)
Several years after saying the pharmaceutical industry was “getting away with murder,” President Donald Trump appears poised to unveil new drug pricing rules that could shake up U.S. pricing dynamics in a big way. But it remains to be seen exactly how the implementation will play out...Trump plans to unveil two major measures—an international pricing index and a rule to crack down on drug rebates...The international pricing index—also called the “most-favored-nations" clause—would tie U.S. prices in Medicare to lower prices abroad. The pharmaceutical industry has intensely resisted the proposal. Eli Lilly CEO David Ricks, for one, characterized it as “horrible” policy, and Pfizer CEO Albert Bourla, Ph.D., said the president’s summer executive orders on drug pricing were “an enormous distraction” amid the COVID-19 fight and threatened American jobs...READ MORE
- FiercePharmaPolitics—Pfizer Vyndaqel copay lawsuit could bring drug pricing shockwaves (fiercepharma.com)
Pfizer’s fast-growing and costly heart meds Vyndaqel and Vyndamax have been the subject of drug pricing scrutiny since their launch in 2018. Now, they’re at the center of a Medicare copay lawsuit that could reverberate around the industry...meds list with prices of $225,000 per year, the company is suing the U.S. Department of Health and Human Services in an attempt to help with Medicare patients with their copays...kickbacks laws prohibit drugmakers from assisting with Medicare patient copays; companies can financially help patients on commercial insurance. The laws are designed to keep a check on drug prices, and one expert told Barron’s a ruling in Pfizer's favor “would be a major earthquake” for the industry...READ MORE
- FiercePharmaPolitics—Trump unveils favored-nation drug pricing executive order, and pharma hits back (fiercepharma.com)Trump’s Drug Price Controls are a Lousy Deal for Patients (cei.org)
After touting a series of executive orders on drug pricing in late July, President Donald Trump has now unveiled the most significant among them—an order tying Medicare's drug prices to much lower costs in other developed countries. The biopharma industry pushed back hard, and it’s unclear exactly when or how the changes would be implemented...The executive order...says Medicare should not buy certain Part B or Part D drugs unless at prices paid by “at a minimum, the lowest price at which the manufacturer sells that drug to any other developed nation.” In Part D, the plan would apply “where insufficient competition exists” and where “seniors are faced with prices" higher than those in other developed nations...READ MORE
- Telemedicine is booming — but many people still face huge barriers to virtual care (statnews.com)Telehealth seems here to stay – so how can it be improved? (healthcareitnews.com)
As Covid-19 drives many patients away from in-person care and toward virtual visits, experts warn that the nation’s most vulnerable members may be shut out of the booming telehealth business...Federal policymakers temporarily relaxed regulations to make it easier to provide virtual care during the pandemic, fueling a shift toward telemedicine that has become so popular among patients and providers that there are now a number of proposals to make the changes permanent. Just this week, President Trump signed an executive order that would permanently extend some of those policies...But a pair of new studies published this week show that there are barriers to virtual visits that regulatory changes alone can’t fix...READ MORE
- 50 plans now offered on Nevada health exchange for uninsured (reviewjournal.com)
...uninsured Nevadans can enroll for health coverage on the state-operated exchange, which this year features more carriers and plans...Insurance plans are available through online marketplace Nevada Health Link to those who don’t qualify for Medicaid or Medicare or don’t have insurance through an employer...“I don’t think that it comes as any surprise to anybody during this COVID era, there’s never been a more important time to connect to comprehensive health care,” Heather Korbulic, executive director of the Silver State Health Insurance Exchange, said...The 50 plans on the exchange, nearly twice as many as last year, cover COVID-19-related testing and diagnosis, she said. They are all so-called qualified health plans that encompass the 10 essential health benefits, including coverage of pre-existing conditions, mandated by the Affordable Care Act. Dental and vision plans also are available...READ MORE
- Trump Says Elderly to Get $200 for Drugs in Bid for Senior Vote (msn.com)Trump Health Policies Again Thrust Drug Pricing and Access into the Spotlight (biopharminternational.com)
President Donald Trump said that Americans in the Medicare program for the elderly and disabled will be sent $200 discount cards for prescription drugs within weeks, potentially putting cash in their pockets ahead of his November re-election...Assuming they are sent to 33 million Medicare beneficiaries, the figure Trump used, the cards would cost about $6.6 billion...Money for the cards will be drawn from a demonstration program Medicare uses to test new payment systems and other projects, and the cost will be offset by future savings generated from new price cuts Trump has ordered for drugs bought by Medicare, according to a White House official. The cards can be used for prescription drugs co-pays, the official said, but didn’t elaborate...READ MORE
- Sutter Health posts $857M loss in first half of 2020 due to COVID-19 (fiercehealthcare.com)
California-based Sutter Health suffered an $857 million loss in the first half of the year thanks to major declines in revenue due to the COVID-19 pandemic...“The need for Sutter to adjust its entire integrated network to respond to COVID-19 has been, and continues to be, a costly and difficult endeavor,”...Sutter experienced rapid declines in patient revenue in the first half of the year as states required the cancellation of elective procedures and patients were hesitant to come back to the hospital...Patient revenue from commercial plans suffered the most, generating $2.7 billion in revenue, a $543 million drop compared with the first half of 2019...Medicare revenue also declined by $179 million in the first half...Like other health systems, Sutter Health got $400 million from a $175 billion provider relief fund passed by Congress as part of the CARES Act...The system also got $1 billion from the Medicare Advance and Accelerated Payment program, which gave out advance Medicare payments to hospitals...Facilities have to start repaying the loans as soon as this month...READ MORE
- CMS: Medicare to cover COVID-19 vaccine at no cost to beneficiaries (fiercehealthcare.com)
The Trump administration announced it will cover a vaccine for COVID-19 at no cost to Medicare beneficiaries...The Centers for Medicare & Medicaid Services released an interim rule on Wednesday that aims to remove regulatory barriers for seniors to get the vaccine, which is expected to be approved by early next year...READ MORE
- CMS: ACOs save Medicare $1.2B under ‘Pathways to Success’ program (fiercehealthcare.com)
A federal program aimed at lowering Medicare costs by incentivizing providers to move from fee-for-service to value-based care models generated $1.2 billion in net savings to Medicare last year, the Centers for Medicare & Medicaid Services announced...CMS Administrator Seema Verma credited savings seen under the Medicare Shared Savings Program to recent rules that shortened the pathway for financial risk...These results are additional evidence that physician-led practices can be successful in generating savings through value-based care..."Once again, physician-led ACOs out-performed hospital ACOs,"..."What we need now is to help more practices participate in these models of care."...READ MORE
- Drug payment cuts to 340B hospitals spur debate on best path forward (healthcarefinancenews.com)
Hospitals say revenue from the 340B program is essential, while others contend the original law is being abused...an federal appeals court ruled that 340B hospitals will now be subject to Medicare cuts in outpatient drug payments by nearly 30%... gives...the Department of Health and Human Services the legal authority to reduce payment for Medicare Part B drugs to 340B hospitals...the action means patients – particularly those who live in vulnerable areas – will pay less out-of-pocket for drugs in the Medicare Part B program...providers...said the 340B decision will hurt hospitals and patients in these vulnerable areas...Hospitals that serve large numbers of Medicaid, Medicare and uninsured patients were getting the drugs for a discounted price, but, getting reimbursed at the higher price...The hospitals...are in the red or operating on thin margins, were using the pay gap in the price difference to cover operational expenses. HHS deemed it inappropriate that these facilities would use Medicare to subsidize other activities and initiatives...READ MORE