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The U.S. Medicare program...proposed deep cuts to how much it reimburses hospitals to buy drugs under a policy that gives some health facilities access to cheaper medicines...The proposal...by the Centers for Medicare and Medicaid Services, would change the rate paid to hospitals for drugs under what’s known as the 340B program. The program gives hospitals who serve many poor patients access to deep discounts on some drugs. The new proposal would significantly cut the payments hospitals receive for those medications...Medicare would essentially be clawing back most of the discount from hospitals, (without any impact to payment made to drug manufacturers)…Medicare would pay hospitals for drugs purchased through the 340B discount program at a price more consistent with the actual cost hospitals and other providers pay to acquire those drugs. Seniors would see those savings passed on to them in the form of lower copays...The changes would cut seniors’ drug costs in Medicare by $180 million a year...Currently, hospitals are reimbursed for the drugs at their average sales price, plus 6 percent. The proposed rule would pay average sales price, minus 22.5 percent. The proposal would selectively hurt hospitals serving the poor, said Tom Nickels, executive vice president of the American Hospital Association.

A total of 412 people, including almost 115 doctors, nurses and other medical professionals, have been charged in the sweeping enforcement action, the biggest ever by the multi-agency Medicare Strike Force, the Justice Department said...More than 120 people were accused of illegally prescribing and distributing opioids and other dangerous narcotics...Amazingly, some have made their practices into multi-million-dollar criminal enterprises...Those charged participated in schemes that billed Medicaid, Medicare and TRICARE...for unneeded drugs and treatments that were often never provided...In many cases, healthcare providers paid cash kickbacks to patients and others in exchange for medical data that would allow them to file fraudulent bills to Medicare...In addition to the hundreds charged, the Department of Health and Human Services has launched suspension procedures against almost 300 medical service providers, including doctors, nurses and pharmacists...

Walgreens Boots Alliance and Rite Aid have called off their $9.4 billion merger agreement. Instead, Walgreens says it will attempt to purchase one-half of Rite Aid's stores for $5.18 billion in cash. Executives said they crafted the smaller deal to address regulatory issues, but antitrust experts said it does not eliminate competition concerns. The Federal Trade Commission's review of the original Walgreens-Rite Aid transaction stretched 18 months, and the commission reportedly did not back away from concerns that the deal would have harmed competition. The commission worried about the merger's impact in regions where both companies have a strong store presence...Walgreens...said the smaller transaction addresses "all substantive" FTC concerns. The company will be adding stores in regions where it currently lacks a large presence, including the Northeast and MidAtlantic..."There's a chance that it won't go, that's the reality of the process. We believe it makes sense, we just have to wait until it plays out."

Nevada is attempting to join 31 other states in expediting health care for immigrant children from low-income families...Implementing speedier coverage will hinge on whether President Donald Trump's administration grants the state permission...If so, an estimated 5,000 minors with green cards, refugee youth and certain other young immigrants will become eligible for Medicaid sooner than previously expected...Gov. Brian Sandoval signed Senate Bill 325...It ends the current five-year wait period for children with residency paperwork to get on government-subsidized health insurance.

Unfortunately, information contained in the label often lags far behind the evolution of a drug’s use. Drug makers can update product labels to include additional uses when new data supports such modifications. In many cases, though, they don’t do this because there’s little incentive to do so, especially when a drug is no longer being actively marketed or when its patent has expired and it faces generic competition...The problem is widespread...Friends of Cancer Research, found that leading oncologists recommended additional uses beyond those listed on product labels for 79 percent of cancer drugs approved between 1999 and 2011. This means that a large number of well-accepted uses of cancer drugs that emerge over time are completely absent from drug labels...Take the drug methotrexate. Despite being the standard of care for a large number of rheumatologic conditions, the drug label lists only three. When labels are missing critical information like this, particularly regarding diseases other than cancer, insurers often refuse coverage, putting added strain on patients...In the long run, letting labels fall out of date will do a lot of damage by undermining reliance on the drug approval process, which was put in place to protect patients and safeguard public health…

Pharmacies continue to ride the 340B Drug Pricing Program’s explosive growth...Our latest...analysis finds that nearly 20,000 pharmacy locations now act as a contract pharmacy for the hospitals and other healthcare providers that participate in the 340B Program. Fewer than 3,000 pharmacy locations were in the program in 2010...Large retail pharmacy chains' rapid expansion into 340B suggests superior profits...How many prescriptions do contract pharmacies provide at discounted prices to uninsured, underinsured, and low-income patients? Are pharmacies engaged in profit-sharing agreements with 340B hospitals? Are they earning fees that far exceed fair market value standards? Who is really benefiting from the contract pharmacy boom?...For instance, an Office of Inspector General study of 340B contract pharmacies found that two out of three hospitals did not offer the 340B discounted prescription price to uninsured patients via these pharmacies…we...have no transparency into the behavior of these 340B contract pharmacies. None of the public companies reports any information about its participation in the 340B program.

The Division of Insurance has announced that Nevada’s insurance carriers that participate in the Silver State Health Insurance Exchange have decided to only offer coverage to Clark, Washoe, and Nye counties beginning in 2018...Currently three medical carriers offer plans on Nevada Health Link:

• Anthem (The only insurance company currently selling statewide)
• Health Plan of Nevada
• Prominence Health Plan

But some changes are coming as of January 1, 2018.

• Anthem & Health Plan of Nevada will only be offering coverage in Washoe, Clark, and Nye Counties.
• Prominence Health Plan announced this week that they will be pulling out of the Nevada Exchange market.
• Two new companies, Aetna and Centene will be joining the exchange market but according to the Division of Insurance at most they will only be offering plans in Washoe, Clark, and Nye counties

The Division of Insurance says this will leave about 8,000 Nevada residents without coverage across 14 counties. The largest group is about 5,000 people across Carson City, Douglas, Lyon, and Storey Counties...If you live outside of Washoe, Clark, or Nye counties and have concerns about your coverage, Silver State Health Exchanges suggests you call them at 855-768-5465...They say that they are working diligently with Governor Sandoval to come up with a plan for those that could be uninsured.

Biosimilars are heralded as an affordable alternative to expensive biologic medications. Despite their potential to reduce the overall cost of treatment, prescriber uptake has been slow. The primary barrier points towards the current reimbursement model: "buy-and-bill."...CMS incentivizes biosimilar use through differential reimbursement, but private payers generally do not use this approach...In new study...investigators examined the dynamics across provider types to determine the impact of provider setting and payer mix on biosimilar adoption...The health care system uses the "buy-and-bill" reimbursement model because biosimilars are administered by injection or infusion. Under this structure, providers are reimbursed for biologics with an additional percentage of the product price added to cover acquisition, storage, and dispensing costs associated with care...This environment disincentives providers from favoring lower-cost biosimilars because reimbursement for biologics typically ranges from 6% of the drug’s average sales price under Medicare coverage to a more robust 9% to 10% reimbursement from typical commercial plans…In designing this coverage model, CMS...mandated that physicians who dispense biosimilars will be reimbursed at ASP plus 6% of the...price,"..."While this mandate was enacted to remove a disincentive for prescribing biosimilars for patients on Medicare, it does not address considerations for patients covered by commercial insurers."...Patients with commercial insurance represent the majority of billings for most providers in the United States…

Ohio’s Board of Pharmacy began reporting sales of gabapentin prescriptions in its regular monitoring of controlled substances. The drug, which is not an opioid nor designated a controlled substance by federal authorities, is used to treat nerve pain. But the board found that it was the most prescribed medication on its list...surpassing oxycodone by more than 9 million doses. In February, the Ohio Substance Abuse Monitoring Network issued an alert regarding increasing misuse across the state...Gabapentin’s ability to tackle multiple ailments has helped make it one of the most popular medications in the U.S. In May, it was the fifth-most prescribed drug in the nation...law enforcement officials and drug counselors say the addition of gabapentin adds a new obstacle. As providers dole out the drug in mass quantities for conditions such as restless legs syndrome and alcoholism, it is being subverted to a drug of abuse. Gabapentin can enhance the euphoria caused by an opioid and stave off drug withdrawals. In addition, it can bypass the blocking effects of medications used for addiction treatment, enabling patients to get high while in recovery...

There will be four insurance companies offering insurance plans on the Exchange with a total of 24 individual health plans to choose from between Clark, Washoe and Nye counties in 2018...The Nevada Division of Insurance has posted a summary of proposed rate changes for Plan Year 2018 on the Division’s website. These proposed rate changes are for plans sold on the Nevada’s health insurance Exchange in the individual market..."Posting these rate changes on the website allows the Division to be transparent with Nevada’s consumers so that they have an opportunity to review these requests from insurance carriers," said Insurance Commissioner Barbara Richardson. "This is also an opportunity for consumers to submit their comments to the Division during this rate review process."...The average proposed rate change for the individual market on Exchange is an increase of 38%.