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Medicaid

July 24, 2014 | Daily News

The National Association of Medicaid Directors sent CMS initial recommendations for revamping Medicaid managed care regulations after hearing informally that the agency hopes to update rules that have been in place since the 1990s, with a key proposal that CMS move away from requiring waivers for any changes states make to Medicaid managed care programs. The Medicaid directors also made a strong pitch to play an active role as CMS crafts regulatory updates.

July 24, 2014 | Daily News

Gilead's revelation Wednesday (July 23) that it sold $3.48 billion of its breakthrough hepatitis C drug Sovaldi in the second quarter of this year alone -- beating even Wall Street expectations -- fueled an already heated national drug pricing debate, spurring health plans, a broad-based stakeholder coalition and lawmakers to again demand the company voluntarily lower the $84,000-per-course cost of the drug. At the same time, a key House Democrat conceded Congress is unlikely to act.

July 23, 2014 | Daily News

HHS announced the hiring of a new senior counselor on Wednesday (July 23) who will report directly to HHS Secretary Sylvia Mathews Burwell and “work very closely with HHS and the CMS leadership to help ensure the success of the second open enrollment period.” Leslie Dach -- a former Walmart executive who was with the company when Burwell led its foundation starting in 2012 -- will fill the new role, the department said.

July 21, 2014 | Daily News

The Health Resources and Services Administration on Monday (July 21) issued an interpretive rule, expected by stakeholders, restating its view that orphan drugs used for non-orphan purposes are subject to 340B drug discounts -- a move the drug industry views as a “government power play” to get around a court ruling in PhRMA's favor and has asked the court to step in.

July 16, 2014 | Daily News

The brand drug industry is pivoting from justifying drug prices based on research and development costs to justifying them based on the product's value to the health care system, a move that comes as key lawmakers, health plans and large employers -- upset by rising drug prices -- urge drug makers to disclose their research spending and their rationale for prices.

July 16, 2014 | Daily News

The drug industry won a lawsuit challenging the administration’s execution of 340B drug-discount program, but now the Health Resources and Services Administration is saying industry will have to sue again if it wishes to challenge the same policy because HRSA is using a different type of regulation to implement its interpretation of how the health law's 340B provision applies to orphan drugs.

July 16, 2014 | Daily News

HHS has created a portal on the CMS website to help states coordinate Medicaid innovation efforts with each other and the federal government, responding to governors' long-standing calls for CMS to make it easier for state Medicaid programs to learn from successful delivery system and payment reforms around the country.

July 16, 2014 | Daily News

A new network of state-regulated compounding pharmacies aims to help compounders that meet a higher bar -- based on accreditation and quality standards -- negotiate with payors and pharmacy benefit managers, which in recent weeks have begun limiting coverage of certain compounded drugs due to the rising costs of the products. The latest move adds to other other recent efforts by compounders to curb the coverage restrictions, which industry, payors and PBMs attribute to billing changes and increased utilization.

July 15, 2014 | Daily News

California expects that six weeks from now it could still have roughly 350,000 pending applications for Medicaid coverage to work through -- a little more than half the number pending at the end of June -- according to its response to CMS' demand that six states submit updated plans by Monday (July 14) for getting through a backlog of Medicaid eligibility determinations and enrollments.

July 15, 2014 | Daily News

The National Coalition on Health Care is spearheading an effort to get drug makers to disclose how much they spend inventing drugs and their rationale for drug prices. The broad-based stakeholder group is trying to set up a meeting with the drug industry and other stakeholders to figure out how the transparency measures would work, but a Pharmaceutical Research and Manufacturers of America official indicated that the drug trade group is not interest in negotiating.

July 14, 2014 | Daily News

The Health Resources and Services Administration revealed Monday (July 14) that it will propose a new interpretive rule on the 340B orphan drug exclusion in the next few days that allows for discounts for non-orphan uses of orphan drugs after a court agreed with the drug industry that HRSA overstepped its authority with a previous orphan drug rule.

Rep. Henry Waxman (D-CA), who was the primary author of the 340B legislation in 1993, said Monday that HRSA's decision is the right one, because the agency's interpretation meets the legislative intent of the law.

July 14, 2014 | Daily News

In the first overhaul of performance criteria that determine accountable care organizations' bonuses, CMS proposed on July 3 to add 12 measures and retire eight of the existing 33 measures.

July 09, 2014 | Daily News

CMS unveiled the second round of health care innovation awards Wednesday (July 9), increasing funding for both rounds of grants to up to $360 million for awards focusing on four areas that include reducing costs for hospital outpatients and testing improvements for certain providers.

July 02, 2014 | Daily News

President Barack Obama's Council of Economic Advisers pointed out that the 24 states that have not expanded Medicaid eligibility under the Affordable Care Act are missing out on billions of dollars in federal funds, economic expansion and better health care outcomes for their residents in a report released Wednesday (July 2).

July 01, 2014 | Daily News

The Government Accountability Office has found that drugs in the Medicare Part D program are more expensive than those purchased under Medicaid, due in part to the latter program's rebates, and in some cases also are more expensive than drugs purchased by the Department of Defense -- a conclusion bolstering key Democrats' view that CMS needs power to negotiate prices.

June 30, 2014 | Daily News

Actuaries should consider the impact of potential breakthrough drugs or devices on spending when establishing the capitation rates for Medicaid managed care plans, health insurance stakeholders tell the trade group representing the nation's actuaries.

June 19, 2014 | Daily News

Democrats on the House Energy & Commerce Committee are using the $1,000-per-pill price of Sovaldi to push for extending Medicaid drug rebates to low-income Medicare beneficiaries.

June 13, 2014 | Daily News

Congressional CHIP advisors on Friday urged Congress to fund the expiring Children's Health Insurance Program for an additional two years, a move viewed as too little by children's health advocates who prefer legislation introduced days earlier by Sen. Jay Rockefeller (D-WV) that would fund the program through 2019.

June 13, 2014 | Daily News

The National Senior Citizens Law Center is asking CMS and the California Department of Health Care Services to suspend passive enrollment in the California demonstration coordinating care for those dually eligible for Medicare and Medicaid after the beneficiary advocates found a series of problems with enrollment and other aspects of the demonstration.

June 10, 2014 | Daily News

Florida will give Medicaid managed care plans a “kick” payment to help cover the higher-than-expected cost of the Hepatitis C drug Sovaldi from May 1 forward, and the state is considering paying plans retroactively to cover some of the costs from the earlier part of the year, according to an investors note from J.P.Morgan.

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