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Medicaid

May 06, 2014 | Daily News

Senate Finance Committee Chair Ron Wyden (D-OR) told Inside Health Policy he is monitoring the debate over the high cost of the breakthrough Hepatitis C drug Sovaldi, but said he is holding off weighing in. He noted that his committee has strongly supported the Medicare Part D drug benefit and his “theory is that you really shouldn’t mess with programs that have worked generally,” but the lawmaker didn't signal what direction he may take on Sovaldi.

May 05, 2014 | Daily News

Nonprofit Medicaid managed care plans are asking CMS to immediately increase pay rates to offset the unexpectedly high cost of the breakthrough Hepatitis C drug Sovaldi and to demand state Medicaid directors swiftly take action.

May 02, 2014 | Daily News

States Medicaid officials and health plans grappling with the high cost of the breakthrough Hepatitis C drug Sovaldi are likely to limit the drugs' availability through prior authorization and clinical guidelines -- many of which could recommend limiting the drug to those with advanced liver disease, sources say.

May 02, 2014 | Daily News

Pressure is increasing on CMS to give states a year to adopt Medicaid drug reimbursement changes driven by the Affordable Care Act, as lawmakers and pharmacy groups have added their voices to states' earlier calls for more time, though those following the issue say CMS has not indicated if it would be amenable to the idea.

May 01, 2014 | Daily News

An HHS official on Thursday (May 1) expressed confidence that pricing and markets will be stable in all states going into next year even though some exchanges saw relatively weak qualified health plan sign-ups in 2014.

May 01, 2014 | Daily News

HHS says roughly 28 percent of all enrollees who chose a plan on the exchanges between Oct. 1 and April 19 were in the coveted 18- to 34-year-old age category and young adults came out in full force in the final weeks of the 2014 season, according to the department's latest report analyzing the more than 8 million people who signed up for qualified health plans.

May 01, 2014 | Daily News

Health plans likely knew the Hepatitis C drug Sovaldi was coming to the market this year and should have had a good idea of what it would cost and how broadly it would be prescribed, drug lobbyists said.

April 30, 2014 | Daily News

A model telehealth policy recently approved by the Federation of State Medical Boards that proposes to limit telemedicine to video technologies and exclude telephone consultations has drawn the ire of some in the telemedicine industry as lawmakers prepare to take a deeper dive into the topic this week.

April 30, 2014 | Daily News

Telehealth advocates and providers are poised to push for more robust telehealth benefits and reimbursement within accountable care organizations and other payment models that may include bundled or capitated payment, as such systems could use services that are sometimes held up because of the fee-for-service system.

April 28, 2014 | Daily News

The head of the group representing the nation's Medicaid directors says managed care plans will be paid “appropriately” for the coverage of a new high-cost Hepatitis C drug, Sovaldi, that was approved by the FDA in December after plans had already negotiated their 2014 rates, but notes that the mechanics of this will not be worked out for some time.

April 28, 2014 | Daily News

Medicaid health plans on Monday (April 28) sought reimbursement from state Medicaid agencies for unexpected spending on a high-cost breakthrough Hepatitis C drug approved by FDA after rates were already negotiated with states, laying out their demands in a letter to the National Association of Medicaid Directors (NAMD).

April 25, 2014 | Daily News

Aetna in a Thursday (April 24) earnings call said it is unlikely to expand it's qualified health plan (QHP) offerings beyond the 17 existing states for 2015 -- chiefly due to the program's constantly changing rules -- and also reported that it picked up 230,000 paid QHP members and expects that number to increase to 450,000 by the end of the year.

April 25, 2014 | Daily News

FDA is weighing how to encourage state officials to enter information-sharing agreements for drug compounding oversight after state stakeholders expressed concerns that some agency requirements, such as those that conflict with some state sunshine laws, pose major legal hurdles, according to recently released minutes of an FDA meeting with state regulators and stakeholders.

April 24, 2014 | Daily News

Centene Corp., in an earnings call this week touting double-digit revenue growth, said that about 39,700 people have enrolled in and paid premiums for qualified health plans (QHPs) the company is offering through the exchanges in nine states but the insurer still expects to have about 70,000 paid enrollees by the second business quarter.

April 23, 2014 | Daily News

The GOP leader of the Florida state Senate sees the impending departure of HHS Secretary Kathleen Sebelius as an opportunity to “recalibrate” the balance of authority in Medicaid and has urged secretary-nominee Sylvia Mathews Burwell to seize a chance to tip unwilling states to embrace Medicaid expansion by adopting a more flexible approach to draw down federal money.

April 22, 2014 | Daily News

The nation's largest insurer during its 2014 first quarter earnings call suggested it will be moving into more public exchanges in the coming year but also noted that it continues to face headwinds due to the Affordable Care Act's insurance tax, sequestration and rate cuts to Medicare Advantage.

April 21, 2014 | Daily News

Medicaid health plans are readying a public push to voice their worries about new, costly Hepatitis C medications that have recently come onto the market and plan to send a letter to state Medicaid directors this week about developing solutions so that plans and the program remain financially solvent, the head of Medicaid Health Plans of America tells Inside Health Policy.

April 17, 2014 | Daily News

The HHS Inspector General recommends that CMS ask Congress to prevent states from using a financing loophole to get federal funding for dually eligible beneficiaries with nearly no investment from states.

April 16, 2014 | Daily News

Outgoing HHS Secretary Kathleen Sebelius has suggested that states that have yet to enroll thousands of Medicaid beneficiaries deemed eligible by healthcare.gov could see reductions in their matching funds if they are unable -- or unwilling -- to quickly clear the logjam.

April 14, 2014 | Daily News

Congressional Medicaid advisors have begun working on addressing concerns with long-term care and could issue recommendations on how to improve the system in one of its 2015 reports.

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