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Nevada may have lost more than $2.1 million because of overbilling, fraud and overall lack of oversight of the same community homes that were found earlier this year to be providing squalid living conditions to the state’s most vulnerable residents...the state’s Division of Public and Behavioral Health likely lost up to $1.5 million in possible overpayments because of overbilling from providers of so-called community-based living arrangement homes for people with mental illnesses — and lost another $600,000 because of a discrepancy in rates paid for similar services...The financial audit...identified various questionable and potentially fraudulent billing practices by those operating the homes, including billing more hours than those recorded on time sheets, reporting serving more than one client at the same time, charging for duplicative services and paying different rates for similar services from various providers...

A day after President Trump signed a massive piece of legislation responding to the opioid crisis into law, the Department of Justice announced it's pouring even more resources into its crackdown on prescribers...Attorney General Jeff Sessions said his agency was creating a new Appalachian Regional Prescription Opioid Strike Force to focus on communities "hit especially hard by addiction and opioid fraud."...a dozen prosecutors and data analysts will operate out of hubs in Cincinnati/Northern Kentucky and Nashville, Tennessee, monitoring the Appalachian region for fraudulent opioid prescriptions by physicians...

Amgen is cutting the list price of its cholesterol drug Repatha by 60% to $5,850 in an unprecedented move to make the drug available to senior citizens...“We’ve got to make sure those who need [Repatha] can get it,” says Robert Bradway, Amgen’s chairman and chief executive. “The losers are the patients who have gone to the pharmacy counter and have not been able to get the medicine they need, and that’s what we need to address as a company, as an industry, and as a society.”...Cardiologists have complained that it has been tremendously difficult to get insurance plans to pay for the drugs, which lower...low-density lipoprotein...This decision will open up access to the most effective LDL-lowering therapy to a much larger group of patients and that has major positive public health implications.”

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

President...Trump...announced a new payment model that would more closely align the cost of Medicare Part B drugs with the prices paid for the same drugs in other countries...As they unveiled the "International Pricing Index" model, federal health officials projected the proposal could save Medicare more than $17 billion over the course of a five-year pilot. The Centers for Medicare & Medicaid Services currently pays the average sales price plus 6% for Part B drugs, and in the new proposal would instead pay a target price based on international prices and look to alternatives for the add-on fee...Medicare currently pays about 180% more than other countries for drugs in Part B, which includes pharmaceuticals that are administered in a clinical setting, HHS Secretary Alex Azar said. Through the IPI model, HHS is looking to bring that figure down to 126%.