GOP Health Reform

Express Scripts is introducing an optional formulary for drugs with alternative drug codes, which starts the move from so-called spread pricing based on rebates to a system that shares those rebates at the pharmacy counter, the pharmacy benefit manager announced Tuesday (Nov. 13).

Dozens of academics in public health and health law told a federal judge that CMS misrepresented studies on the relationship between work and health when the agency approved Arkansas’ controversial program of Medicaid work requirements.

While stakeholders expect lawmakers to focus less on Medicare than other health policy in the new Congress, strengthening Medicare is still part of Rep. Frank Pallone's (D-NJ) agenda for the House Energy & Commerce Committee, advocates hope Democrats will look at coverage gaps in the program, and lobbyists say lawmakers could take another look at the site-neutral cuts included in CMS’ recent hospital pay rule.

A federal judge has temporarily shut down a Florida-based operation that the Federal Trade Commission charged with misleading consumers into thinking they were purchasing comprehensive, ACA-compliant coverage, rather than skimpy products that left them with unpaid medical claims and thousands in bills.

HHS Secretary Alex Azar on Thursday (Nov. 8) said CMS plans to both bring back the mandatory bundled-pay models the agency canceled last year and look at new models, including for radiation oncology.

The Trump administration released two final rules on Wednesday (Nov. 7) that offer exemptions to the Affordable Care Act’s contraceptive mandate for entities that have either religious or moral objections to contraceptive services.

In the immediate aftermath of the midterm elections, House Minority Leader Nancy Pelosi (D-CA) asked the Trump administration to “withdraw from a lawsuit” to eliminate parts of the Affordable Care Act, and Senate Minority Leader Chuck Schumer (D-NY) told Inside Health Policy he would join Pelosi’s call for the GOP to scrap the suit.

Voters in Idaho, Nebraska and Utah chose Tuesday (Nov. 6) to expand Medicaid eligibility under the Affordable Care Act, but voters in Montana rejected a ballot initiative that would have made that state’s Medicaid expansion permanent.

Prior to the midterm elections, Senate Democratic staffers prepared for a split Congress, with a GOP-controlled Senate and a Democratic House, by meeting with health care stakeholders and their House counterparts to coordinate next steps and make plans to re-frame the push for Obamacare market stabilization as a way to protect people with preexisting conditions, sources close to the Senate health committee say.