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Medicaid

October 21, 2014 | Daily News

The Health Resources and Services Administration has told more than 50 drug manufacturers to refund 340B hospitals for certain orphan drugs charged at non-discounted prices, complaining the companies did not follow the agency's controversial orphan drug policy that has been the subject of two drug industry court challenges.

HRSA told Inside Health Policy a letter was sent on Oct. 7 giving the manufacturers 30 days to “notify HRSA of plans to repay affected covered entities and to institute the offer of the discounted price in the future.”

October 20, 2014 | Daily News

Congress could allow for binding arbitration to help plans negotiate lower prices for unique specialty drugs, Harvard professors wrote in a January 2008 Health Affairs article that is getting new attention in light of the $94,500 price of a 12-week course of the newly approved hepatitis C drug Harvoni. The Center for a Responsible Federal Budget drew attention to the old proposal to help advance the debate over how, or whether, steps should be taken to control the price of specialty drugs.

October 17, 2014 | Daily News

UnitedHealth Group, which entered only a handful of health insurance exchanges in year one, is on track to participate in about about two dozen states in 2015, United executives said in an earnings call with investors. United expects to be profitable in the exchange market over the long term, but officials say it will fall short of its goal of 3 to 5 percent margins in that sector next year. In the Medicaid arena, United is on course to grow by just under 1 million new members, which a company official touted as a record level of organic growth.”

October 16, 2014 | Daily News

The ACA's Patient-Centered Outcomes Research Institute will meet Friday to gather public input on whether comparative effectiveness research could inform hepatitis C treatment. Some of the research questions that PCORI will likely be asked to fund target reimbursement restrictions that states have put in place on Gilead Science's hepatitis C drugs, and a PCORI official says the institute does not intend to compare breakthrough hepatitis C drugs to older, less effective treatments.

October 10, 2014 | Daily News

Gilead Science's revelation Friday (Oct. 10) that it will charge $94,500 for a 12-week course of its newly approved hepatitis C drug Harvoni, though less than some market analysts had expected, stoked the national drug pricing debate, with drug price-control advocate promptly urging Congress to stem a brewing crises of what they called “excessive pricing” by drug makers.

October 09, 2014 | Daily News

CMS says that states should reimburse Medicaid managed care plans for the Affordable Care Act's health insurance provider fee, and says that the fee itself should be incorporated into plans' capitation rates, however, as the firm JP Morgan notes, the agency leaves some “wiggle room” on whether states should also factor in other potential effects of the fee, such as its non-deductibility status.

October 09, 2014 | Daily News

HHS officials and advocates for people with disabilities are advising Medicaid managed care organizations (MCOs) to pay close attention to how states implement a new home and community-based services rule issued by CMS earlier this year. One advocate warned insurers last week that states' failure to fully live up to the new HCBS rules could make MCOs the target of lawsuits.

October 03, 2014 | Daily News

Key Republican lawmakers question CMS' ability to oversee a $7 billion contract awarded by the innovation center to drive demonstrations on major delivery reforms across agency programs, raising their concerns in a letter to CMS Thursday (Oct. 2) as the innovation center was seeking stakeholders' input on a wide array of potential innovations.

October 03, 2014 | Daily News

CMS is seeking stakeholders' advice on whether the agency should test Medicaid managed care reforms in the areas of pharmacy and medication management, value-based insurance design, telehealth, hospice care, long term services and supports, network design, behavioral health, and provider incentive arrangements like accountable care organizations in order to potentially reduce costs while improving quality of care.

October 02, 2014 | Daily News

The National Governors Association is kicking off a year-long project in Alabama, Nevada and Washington state to study workforce transformation, multi-payer initiatives, and sharing savings efforts underway in those states' Medicaid programs for potential broader application. Carol Backstrom, program director for NGA's health division, said she hopes that CMS and the states will come to agreement on promising concepts for statewide Medicaid transformation, although she cautioned that NGA is in the early stages of the process.

October 02, 2014 | Daily News

The HHS Office of Inspector General Report is urging CMS to strengthen its oversight of Medicaid managed care access after finding that state requirements vary widely. The agency, which is preparing for its first major update of Medicaid managed care regulations, agreed with the OIG's recommendations and said it is working to develop guidance for states.

October 01, 2014 | Daily News

Gilead Sciences will price its soon-to-be-approved hepatitis C combination drug Harvoni close to the near-$100,000 cost of the current 12-week regimen of Sovaldi plus pegylated interferon and ribavirin, Gilead President and CEO John Milligan said Wednesday (Oct. 1). Insurance companies and others, including employers, hospitals and state officials, are pressuring Gilead to lower Sovaldi's price, and they anxiously await to see how the company prices Harvoni.

October 01, 2014 | Daily News

Manhattan Institute senior fellow Avik Roy is pitching a universal exchange proposal – which would gradually shift beneficiaries from Medicare and Medicaid into exchange plans – as an idea that would achieve the bipartisan goals of reducing government spending and improving health care for the poor. Recent health care Obama aide Chris Jennings said it might be possible for Congress to accomplish some of Roy’s ideas, but a lot rides on the outcome of the midterm elections.

October 01, 2014 | Daily News

Medicaid directors sent CMS a third set of proposals for updating Medicaid managed care regulations that ask the agency to give states leeway in setting policies on network adequacy, enrollment, managed long-term services and supports, and communications with beneficiaries. States are best suited to understand the nuances and specific needs of their distinct Medicaid populations, the directors say, warning that national, one-size-fits-all regulations from the agency could undermine the program.

October 01, 2014 | Daily News

A bipartisan, bicameral group of lawmakers from the House Energy and Commerce Committee and the Senate Finance Committee are asking trade groups that represent Medicaid managed care plan providers to provide information on how plans provide cost savings and quality health care as a majority of Medicaid beneficiaries find themselves in some type of managed care program. Medicaid Health Plans of America President and CEO Jeff Myers said the timing of the request is perfect because his group plans to publish a compendium of best practices for Medicaid managed care plans later this month.

September 30, 2014 | Daily News

CMS is considering letting accountable care organizations combine with drug plans and Medicaid and accept global payments, CMS innovation center head Patrick Conway said Tuesday (Sept. 30). The agency plans to soon request input from the public on plan designs for CMS to test, and that “request for information” will provide an opportunity for plans to suggest changes to ACOs.

September 26, 2014 | Daily News

U.S. patient advocate groups and labor unions are ratcheting up their effort to convince the Obama administration to back away from provisions it has proposed in the Trans-Pacific Partnership (TPP) negotiations that the groups fear could help multinational drug companies drive up pharmaceutical prices under public health programs in the United States.

September 26, 2014 | Daily News

U.S. Trade Representative employees tried to reassure consumer advocates and unions during a meeting this summer that a draft Trans-Pacific Partnership deal would not lead to companies blocking government efforts to control the cost of specialty drugs in Medicaid, Medicare Part B and other government programs.

September 25, 2014 | Daily News

Governors suggest in a new report that states consider easing restrictions on physician assistants to help deal with swelling Medicaid rolls. The National Governors Association says states should consider including PAs in the definition of "provider," loosening so-called scope-of-practice laws to let physicians delegate more tasks to PAs, opening clinical training sites and encouraging PAs to work in primary care.

September 25, 2014 | Daily News

Researchers at Harvard and Brown universities are analyzing state Medicaid programs' coverage restrictions for the expensive hepatitis C drug Sovaldi, and the findings could lay the groundwork for beneficiaries to sue states, although a Harvard law instructor said legal action is a last resort. Patient advocates are especially angry at states that refuse to give the hepatitis C drug to alcoholics and drug addicts, arguing the policy is discriminatory and has no medical basis.

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