Category:

New York City will spend at least $100 million to ensure that undocumented immigrants and others who cannot qualify for insurance can receive medical treatment, Mayor Bill de Blasio announced on Tuesday morning...The mayor’s office was quick to say that its plan, to be called NYC Care, would not be a substitute for any universal health care at the state level or a national single-payer plan. But, aides said, it was something the city could do immediately and on its own, and not require approval from the State Legislature...The NYC Care plan would improve that coverage, which already insures some 516,000 people, and aim to reach more of those who are eligible, such as the young and uninsured, and others who qualify but have not applied...It would also provide direct city spending, about $100 million per year when fully implemented, on those without insurance, including undocumented immigrants, who already can receive care at the emergency rooms of city-run hospitals...Details of how those seeking care could do so under the new plan were not immediately clear...

A federal judge in Maryland said The Johns Hopkins University, Bristol-Myers Squibb Co and the Rockefeller Foundation must face a $1 billion lawsuit over their roles in a 1940s U.S. government experiment that infected hundreds of Guatemalans with syphilis...In a decision on Thursday, U.S. District Judge Theodore Chuang rejected the defendants’ argument that a recent Supreme Court decision shielding foreign corporations from lawsuits in U.S. courts over human rights abuses abroad also applied to domestic corporations absent Congressional authorization...Chuang’s decision is a victory for 444 victims and relatives of victims suing over the experiment, which was aimed at testing the then-new drug penicillin and stopping the spread of sexually-transmitted diseases...

Babies requiring care in the neonatal intensive care unit...can cost the hospital thousands of dollars daily, depending on the equipment or medication required to keep them stable, said Sunrise CEO Todd Sklamberg...But Medicaid, the insurer for about 70 percent of the hospital’s NICU patients, only pays up to $1,487 daily per baby...The discrepancy left Sunrise Hospital with $77 million in uncompensated costs for intensive infant care last year...Without a bump in payments for the hospital with the most pediatric acute care beds in the state and the only dedicated pediatric cardiology unit in Nevada, Sklamberg said he worries some of the hospital’s highest cost services...will disappear...Nevada’s Medicaid program is one of just a few nationwide to pay on a per diem rate...Most states reimburse hospitals based on what’s called a diagnosis-related group — a code that ties a reimbursement rate to the level and type of services provided by the hospital. But Nevada uses a flat dollar amount of $1,487 to pay back high-level NICUs, no matter the level of care provided...

Laura Joszt, Managing Editor at The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

Big Pharma got a reprieve in Philadelphia last month, but only temporarily...city council paused its proposal to regulate pharmaceutical sales reps when the bill’s co-sponsors pulled it at the final meeting of the year, but they committed to taking it up again in 2019...Councilman Bill Greenlee and Councilwoman Cindy Bass announced they were pulling the proposal before a vote could be taken...and blamed new opposition on the fact that Big Pharma "has unleashed its money and reach to cause hysteria and spread false information.”...Greenlee accused the industry of “bullying” local businesses “when pharmaceutical companies threatened to pull any future medical conventions from the city because of the ‘perception’ of the legislation.”...The proposed “Pharmaceutical Sales and Marketing Practices” gifts and conduct ordinance would regulate pharma manufacturer reps in the city with measures such as having to register with the city, which includes a fee, and prohibiting any gifts to healthcare providers and office staff...follows efforts from other cities such as Chicago, which passed an ordinance to require sales rep licensing that went into effect in July 2017. Nevada also requires pharma manufacturers to submit a list of sales reps working in the state, report gifts or freebies over $10 and provide a list of drug samples distributed...

Laura Joszt, Managing Editor at The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

A federal judge has blocked a Trump administration policy that reduces payments to hospitals under a drug discount program, ruling...that the government overstepped its authority in an attempt to address the high cost of prescription medications...The decision is a win for the 2,000-plus hospitals participating in the program, known as 340B, most of which serve large numbers of low-income patients...In 2017, the Department of Health and Human Services reduced its reimbursements for some drugs by about 28 percentage points...

If you want a glimpse of how single-payer health care would work, look at what’s happening to Sunrise Hospital and Medical Center...As the Review-Journal’s Jessie Bekker reported Wednesday, 70 percent of the families who use Sunrise’s neonatal intensive care unit are on Medicaid. Sunrise CEO Todd Sklamberg says that Medicaid pays the hospital a flat daily rate of $1,487 per baby. That’s around one-tenth of Sunrise’s average daily charge of $14,815...Mr. Sklamberg said the hospital’s deficit for uncompensated infant care was $77 million last year. If the Legislature doesn’t increase Medicaid reimbursement rates this session, he said, Sunrise will consider reducing NICU services for all patients. The hospital, he said, is on an “unsustainable trajectory.”...This is the aspect of single-payer health care that Bernie Sanders doesn’t talk about...

Nicole Grassano, PTNN, Pharmacy Week in Review, this weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings and more.

The Food and Drug Administration is looking for "pathways" to legalize the sale of CBD oil and other cannabis-based compounds in food and beverages in a move that could remove one of the last remaining legal hurdles for companies hoping to sell such products across state lines...FDA Commissioner Scott Gottlieb outlined steps the agency is considering in regulating cannabis products after President Donald Trump signed the farm bill into law on Thursday. The legislation — an $867 billion, five-year spending bill that funds agricultural, nutrition and other federal programs — also loosened some federal restrictions on cannabis. It legalized hemp by removing it from the Controlled Substances Act while preserving the FDA's authority to regulate the products...