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The Daily Scan

Last Updated: 8:50 AM EST


  • U.S. Department of Health and Human Services has announced that Medicare Advantage plans will be able to use tools employed by private-sector insurers to negotiate lower prescription drug prices for patients. HHS Secretary Alex Azar wrote, "President Trump promised better Medicare negotiation and lower drug prices for the American people. Today, we are taking an important step in delivering on that promise. By allowing Medicare Advantage plans to negotiate for physician-administered drugs like private-sector insurers already do, we can drive down prices for some of the most expensive drugs seniors use. “As soon as next year, drug prices can start coming down for many of the 20 million seniors on Medicare Advantage, with more than half of the savings going to patients." (HHS.gov)

  • The Centers for Medicare and Medicaid Services has announced that for the first time, CMS will provide Medicare Advantage plans. Patients will now have the option of negotiating for Part B drugs in a way that lowers costs and improves the quality of care. Medicare Advantage plans that also offer a Part D benefit will be able to cross-manage across Part B and Part D, so that patients receive the best medicine whether it is physician-administered or self-administered. CMS administrator Verma commented, “for too long, Medicare Advantage plans have not had the tools to negotiate a better deal for patients. Today we begin lifting those barriers so plans can use private-sector tools to drive down the cost of expensive drugs while also offering new care coordination and drug adherence programs, to ensure that patients are getting high quality care at lower cost.” (CMS.gov)

  • In a memorandum to Medicare Advantage Organizations, the Centers for Medicare & Medicaid Services announced new flexibility related to the use of step therapy in coverage of Part B services. The agency will allow MA plans to impose step therapy requirements for covered Part B drugs beginning in the 2019 plan year. Administrator of CMS, Seema Verma wrote, "in addition, CMS will consider rulemaking related to step therapy that might be appropriate for 2020 and future years. We remind MA organizations that the regulatory requirement to properly disclose policies and procedures to enrollees in accordance with 42 CFR § 422.111 remains. We also remind MA organizations of their statutory obligations to furnish and provide access to benefits that are available under Parts A and B. As such, CMS intends to treat step therapy for Part B drugs in a manner similar to our other requirements around prior authorization of Part C benefits and services." (AHA.org, Memorandum)


  • As the lawsuit continues between Health and Human Services and the American Hospital Association, new figures have been released by HHS. The defendants (HHS) released a status report and response to the plaintiffs (AHA) proposed to non-deadline remedies. The secretary's remedy response has stated, "indeed, the circumstances of the case have changed dramatically following the Court’s last hearing in March of this year because Congress has since appropriated significant additional funding to the Office of Medicare Hearings and Appeals (“OMHA”) that will allow OMHA to hire numerous new ALJs and staff and more than double its current adjudication capacity. Given this appropriation, HHS is now able to project that, with a continuation of current funding levels, the Secretary will be able to eliminate the backlog entirely in FY 2022." (AHA.org)

  • AstraZeneca LP has agreed to pay $110 million to the state of Texas to settle lawsuits accusing the company of falsely marketing its drugs Seroquel and Crestor in violation of the Texas Medicaid Fraud Prevention Act. Texas Attorney General Ken Paxton said the company was accused of using misleading marketing schemes at a time when it was already under strict obligations of a 2010 federal “corporate integrity agreement” resulting from prior allegations. (Law360.com)

Private Sector

  • Tenet Healthcare has sold off its three acute care hospitals in Chicago in a transaction that closes the Dallas-based hospital chain's entry into the market a half-decade ago. Tenet released report results for the second quarter, while reporting net income from continuing operations available to Tenet common shareholders of $24 million in the second quarter of 2018 compared to a $56 million net loss from continuing operations in the second quarter of 2017. Ronald A. Rittenmeyer, Executive Chairman and CEO commented, “we are becoming a more agile and decisive organization and are pleased with our strong financial results for the third quarter in a row, we have demonstrated our ability to appropriately minimize costs, which will be an ongoing fundamental part of how we do business. Our top priorities remain strengthening our portfolio, delivering more consistent organic growth and taking additional steps to enhance our margins and free cash flow.” (Investor.TenetHealth.com)

#Regulation #Litigation #PrivateSector


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