- The week in hospital M&A
- FDA approves new class of multiple myeloma drug
- Is the behavioral health access problem actually a quality problem?
- Is the behavioral health access problem actually a quality problem?
- Westchester Medical Center names chief medical officer
- Strengthening the backbone of care: 7 rural workforce transformation strategies changing the labor landscape
- Ochsner Health back in the black through H1
- PA pay by specialty: cardiothoracic, vascular surgery top $162K
- Nurses at SSM Health outpatient practices move to unionize
- 6 recent hospital, health system CFO moves
- 62% of ASCs cancel, delay cases over anesthesia gaps
- The secret to success behind the top 1% of American hospitals
- Processed Foods Linked To Prostate Cancer Risk
- Novant Health gets North Carolina OK to build $324M hospital
- Screen Time Is Not All Bad For Kids' Brains
- Winter Is Coming: How Vaccines Help Protect Against Respiratory Illness
- Updated Statement Regarding the Division of Corporation Finance’s Role in the Exchange Act Rule 14a-8 Process
- Sleep Disturbances Linked To Genetic Alzheimer's Risk
- Pre-K Sets Kids Up For School Success, Study Says
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- People With Disabilities Say Medicaid Income Limits Stifle Career Advancement
- A genomics library for the AI era
- BMS bags first FDA approval for CELMoD franchise with Zenbexus multiple myeloma nod
- Trump Team’s Use of Arcane Budget Rule Threatens Medicaid Coverage
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- Massachusetts moves to restrict kratom sales
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- Fierce Pharma Asia—Legend’s first profit; Taiho, Cullinan’s EGFR win; WuXi AppTec’s reprieve
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- 25 state behavioral health policy updates
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- Physician independence is making a comeback — why ASCs are leading the way
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- Dentists battle insurance woes: 5 updates
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- 4 injured after car crashes into North Carolina pediatric dental office
- Ellis Hospital sues St. Peter’s over cardiologist noncompetes, warns of $75M revenue risk
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- A look at where Aetna is seeing value-based care success in Medicare Advantage
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- UNC Health Pardee completes 23-bed behavioral health center
- Oregon State Hospital superintendent out after less than a month
- Affordable Care completes recapitalization, enters ‘next chapter’ of growth
- March of Dimes: Maternity care deserts persist, Medicaid cuts threaten to curb access further
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- Socializing: A Prescription For Healthier Brain Aging
- Taking The Stairs May Lower Your Risk Of Dying From Heart Disease
- Obesity not a 'zero-sum game' as patients crave optionality, Novo CEO says: Reuters
- AZ's blood pressure newcomer Baxfendy fails to meet cost-effectiveness bar, ICER says
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- Gambling Linked To Mental Health Problems Among College Students
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- Listen to the Latest ‘KFF Health News Minute’
- People With Disabilities Say Medicaid’s Limits on Income Stifle Career Advancement
- Readers Speak Out on Work Requirements, Federal Data Grab, Opioid Payback Cash
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- Federal agencies release ‘Treatment First’ toolkit
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- Appeals court tosses methodology for calculating NSA qualifying payment amounts
- UC San Diego Health, West Health launch $40M accelerator for 'tech-forward' coordinated care
- Epic releases Care Everywhere diagnostic image exchange to tackle healthcare's 'CD problem'
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Michigan healthcare freedom community forum
The breathtakingly expensive blood thinner Eliquis, used so much to counter COVID 19 symptoms, is at the top of the list:
HHS Selects the First Drugs for Medicare Drug Price Negotiation
For the first time, Medicare will be able to negotiate prices directly with drug companies, lowering prices on some of the costliest prescription drugs.
For the first time, thanks to President Biden’s Inflation Reduction Act – the historic law lowering health care costs – Medicare is able to negotiate the prices of prescription drugs. Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the first 10 drugs covered under Medicare Part D selected for negotiation. The negotiations with participating drug companies will occur in 2023 and 2024, and any negotiated prices will become effective beginning in 2026. Medicare enrollees taking the 10 drugs covered under Part D selected for negotiation paid a total of $3.4 billion in out-of-pocket costs in 2022 for these drugs.
“For far too long, pharmaceutical companies have made record profits while American families were saddled with record prices and unable to afford life-saving prescription drugs. But thanks to the landmark Inflation Reduction Act, we are closer to reaching President Biden’s goal of increasing availability and lowering prescription drug costs for all Americans,” said HHS Secretary Xavier Becerra. “Although drug companies are attempting to block Medicare from being able to negotiate for better drug prices, we will not be deterred. The Biden-Harris Administration will continue working to ensure that Americans with Medicare have access to innovative, life-saving treatments at lower costs.”
The Biden-Harris Administration has made lowering prescription drug costs and improving access to innovative therapies a key priority. Alongside other provisions in the new law that increase the affordability of health care and prescription drugs, allowing Medicare to negotiate prescription drug prices will strengthen the program’s ability to serve people with Medicare now and for generations to come. The negotiation process will consider the selected drug’s clinical benefit, the extent to which it fulfills an unmet medical need, and its impact on people who rely on Medicare, among other considerations, such as costs associated with research and development as well as production and distribution for selected drugs. As a result of negotiations, people with Medicare will have access to innovative, life-saving treatments at lower costs to Medicare.
The selected drug list for the first round of negotiation is:
- Eliquis
- Jardiance
- Xarelto
- Januvia
- Farxiga
- Entresto
- Enbrel
- Imbruvica
- Stelara
- Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill
These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, or about 20%, of total Part D gross covered prescription drug costs between June 1, 2022 and May 31, 2023, which is the time period used to determine which drugs were eligible for negotiation. CMS will publish any agreed-upon negotiated prices for the selected drugs by September 1, 2024; those prices will come into effect starting January 1, 2026. In future years, CMS will select for negotiation up to 15 more drugs covered under Part D for 2027, up to 15 more drugs for 2028 (including drugs covered under Part B and Part D), and up to 20 more drugs for each year after that, as outlined in the Inflation Reduction Act.
View a fact sheet from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at: https://aspe.hhs.gov/reports/aspe-ira-drug-negotiation-fact-sheet .
View a CMS fact sheet on the drugs selected for the Medicare Drug Price Negotiation Program at: https://www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf - PDF.
More information on the Medicare Drug Price Negotiation Program is available at https://www.cms.gov/inflation-reduction-act-and-medicare/medicare-drug-price-negotiation .
Reuters, today, lists the eight lawsuits challenging drug price negotiations on constitutional grounds here:
https://www.reuters.com/legal/court-challenges-medicare-drug-price-negotiation-plan-2023-08-29/
This Zerohedge republication from Epoch Times doesn't mention price negotiation.
Still, it seems likely to intersect with the coverage price explosion they predict, given the complex interference congress set up with the Inflation Reduction Act.
https://www.zerohedge.com/personal-finance/retirees-face-steep-hikes-prescription-premiums-2024
Retirees Face Steep Hikes In Prescription Premiums In 2024
Authored by Amie Dahnke via The Epoch Times (emphasis ours),
Retired Americans enrolled in Medicare's Part D prescription coverage could see their premiums increase by 42-57 percent in 2024, a new analysis by HealthView Services has found.
Early indicators show significant cost hikes for retirees in the five states with the largest senior populations. This is different from an earlier report projecting slight premium declines across Part D plans next year.
Major Discrepancy in Premium Outlooks
The HealthView report, published in November 2023, contrasts sharply with a July projection by the Centers for Medicare & Medicaid Services, the federal agency that administers the Medicare program,
The CMS said there would be a 1.8 percent decline in Part D premiums for 2024, citing the Inflation Reduction Act's reforms as the basis for stable or reduced costs.
However, HealthView tells a different story. It forecasts major hikes for retirees in states with large senior populations.
Projected 2024 premiums are $1,404 in California, $1,246 in Florida, $1,154 in Texas, $1,469 in New York, and $1,189 in Pennsylvania. This represents average increases ranging from $269 in Texas to $510 in New York.
What is Driving the Increase?
The key driver of projected premium hikes is a change in the Inflation Reduction Act lowering the maximum out-of-pocket spending cap for Medicare Part D prescription drugs from $7,050 in 2023 to $2,000 in 2025. This will reduce co-pays for some, especially those with chronic conditions.
However, financial liability will shift to insurers expected to cover 60-80 percent of costs once patients hit the new $2,000 cap.
With roughly a quarter of Medicare recipients exceeding this threshold, HealthView analysis suggests carriers will raise premiums to account for their increased coverage requirements. The higher premiums are a way for insurance companies to cover the expected increase in costs.
So, while the Inflation Reduction Act aims to lower overall healthcare costs for retirees, it may actually increase 2024-2025 Part D premiums for 75 percent of enrollees seeing no co-pay relief.
Why It Matters?
Americans pay for prescription drugs over 2.5 times more than other high-income nations. One in five seniors alter medication use due to high prescription costs, a May 2023 national survey found. They either skipped, delayed, took less medication, or took someone else's medications.
Even small Part D premium hikes could strain budgets when combined with other costs. The Council of Aging reports the national average at $2,000 annually for Part B plus another $3,600 a year for supplemental coverage like Medigap Plan F.
With health costs a top concern for retiring Americans, the HealthView analysis shows 2024 increases could outpace the average retiree's Social Security cost-of-living adjustment (COLA) by 70 percent. For those on fixed incomes, outpacing COLA adjustments poses real financial challenges.
Looks like another epic failure of top-down healthcare control.
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