The Daily Scan

August 30, 2018

Last Updated: 8:55 AM EST

Medicare

  • The Centers for Medicare & Medicaid Services (CMS) issued a memo yesterday to Medicare Part D plans, which cover prescription drugs that beneficiaries pick up at a pharmacy, offering plans new tools and flexibility to expand choices and lower drug prices for patients. Currently, if a Part D plan includes a particular drug on its formulary, the plan must cover that drug for every FDA-approved indication, or patient condition, even if the plan would otherwise instead cover a different drug for a particular indication. The requirement to cover drugs in this manner can discourage Part D plans from including more drugs on their formularies and limit their power to negotiate discounts. Yesterday's memo explains that starting in 2020, plans will have new flexibility to tailor their formularies so that different drugs can be included for different indications. This policy, known as “indication-based formulary design,” is used in the private sector and will enable Part D plans to negotiate lower prices for patients. Targeted formulary coverage based on indication will also provide Part D beneficiaries with more drug choices and will empower beneficiaries to select a plan that is designed to meet their unique health needs. (CMS.gov)

Medicaid

  • Earlier this week, the California State Assembly approved passage of Senate Bill 1108, which prohibits work requirements as a condition of Medi-Cal eligibility. Authored by Senator Ed Hernandez, O.D. (D-West Covina) and approved by a vote of 50-18, SB 1108 was introduced after the Trump Administration invited states to revise their Medicaid programs to include punitive requirements that will lead to fewer people with health insurance. This bill ensures that California stands firmly against this concept, and continues to prioritize access to health care for some of our lowest-income residents. (SD22.Senate.CA.gov)

Legislation

  • Yesterday U.S. Senator Tammy Baldwin (D-WI) introduced new legislation to overturn the Trump administration’s final “junk insurance” plan rule. Senator Baldwin’s new resolution of disapproval is cosponsored by 30 Senators and would rescind the Trump administration’s rule expanding “junk insurance” plans that don’t have to provide health care coverage for people with pre-existing conditions. “The Trump Administration is rewriting the rules on guaranteed health care protections that millions of Americans depend on. They are moving forward on an expansion of junk insurance plans that can deny coverage to people with pre-existing conditions and don’t have to cover essential services like prescription drugs, emergency room visits and maternity care,” said Senator Baldwin. (Baldwin.Senate.gov)

Research

  • The National Center for Health Statistics released a new report titled "Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–March 2018" which presents selected estimates of health insurance coverage for the civilian noninstitutionalized U.S. population based on data from the 2018 National Health Interview Survey (NHIS), along with comparable estimates from previous calendar years. The report concluded that in the first 3 months of 2018, the percentage of persons of all ages who were uninsured at the time of interview was 8.8% (28.3 million). There was no significant change from the 2017 uninsured rate of 9.1% (29.3 million). (CDC.gov)

 

  • A new report from Oliver Wyman, commissioned by UnitedHealth Group, analyzes the impact of the ACA’s tax on health insurance premiums. This report provides an analysis of the impact of the tax on health insurance premiums beginning in 2020. The report estimates that the tax on health insurance will increase premiums by 2.2% in 2020 and in subsequent years when the amounts collected in taxes is mandated to increase at the same level as premium growth. Furthermore, it estimates that about 142 million consumers and/or their plan sponsors (in the case of Medicaid and subsidized exchange plans) could be impacted by the tax on health insurance. (Health.OliverWyman.com)

 

 

 

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