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The Weekly Scan

Last Updated: 1:00 PM EST

Medicare & Medicaid

  • On Monday, the CMS finalized updates that will take significant steps in continuing the Trump administration’s efforts to increase competition among Medicare Advantage and Part D plans so patients get higher quality care at lower costs. These changes will increase plan choices and benefits, and include important actions to address the opioid crisis. Last year, CMS empowered patients through expanding the definition of health related supplemental benefits that Medicare Advantage plans could offer to enrollees, where the primary purpose of the benefits are daily maintenance of health. Beginning in 2019, Medicare Advantage plans can now offer supplemental benefits that are not covered under Medicare Parts A or B, if they diagnose, compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization. (CMS.gov)

  • Governor Janet Mills announced Wednesday that the CMS has approved Maine’s State Plan Amendments to expand Medicaid (MaineCare) under the Affordable Care Act. CMS approved the state’s plan retroactive to July 2, 2018, which was the date indicated in the 2017 ballot initiative supported by nearly 60% of Maine voters. MaineCare expansion is projected to provide coverage to approximately 70,000 people throughout the state. With the approval, the federal government will finance more than $800 million in estimated costs for those who enroll under expansion from July 2, 2018 through state fiscal year 2021. Maine is among 36 states plus the District of Columbia that have expanded Medicaid. “This approval marks the culmination of a long-overdue effort to fulfill the will of Maine voters and help tens of thousands of people access health care,” said Governor Janet Mills. “The benefits of expansion – including this injection of hundreds of millions of dollars of federal funds – will extend to rural hospitals, to businesses, and to our economy as a whole. In the coming months, my Administration will work with partners across the state to ensure that those who qualify enroll and receive the health care they need to live healthy lives and remain in the workforce.” (Maine.gov)

  • The federal government and Gov. Mike Dunleavy want Alaska to be the first state to fund Medicaid through a block grant. This means the state would receive a fixed amount of federal money instead of the open-ended commitment under the current approach. It would limit the amount of Medicaid funds coming to Alaska, but it would allow the state more flexibility in how it operates the program. Dunleavy told President Donald Trump in a letter dated March 1 that top federal Medicaid official Seema Verma has urged Alaska to be the first state to receive Medicaid dollars as a block grant. “We are eager to do this, but your support of her on this ‘first’ will keep the proper focus and speed on the application,” Dunleavy wrote Trump. Dunleavy spokesman Matt Shuckerow said a block grant could allow the state more flexibility in how it spends Medicaid funding. “The overall message here that we sent to the president is that we’re open and willing to take flexible measures that can help improve savings and efficiencies within the government,” Shuckerow said. (KTOO.org)

Prescription Drug Pricing

  • Cigna and Express Scripts on Wednesday announced the launch of the Patient Assurance Program, which will ensure eligible people with diabetes in participating plans pay no more than $25 for a 30-day supply of insulin. "For people with diabetes, insulin can be as essential as air. We need to ensure these individuals feel secure in their ability to afford every fill so they don’t miss one dose, which can be dangerous for their health," said Steve Miller, M.D., executive vice president and chief clinical officer, Cigna. "Together, Cigna and Express Scripts are now able to give people who rely on insulin greater affordability and cost predictability so they can focus on what matters most: their well-being." The Patient Assurance Program will be available to members in participating non-government funded pharmacy plans managed by Express Scripts, including Cigna and many other health plans, with out-of-pocket costs for insulin greater than $25. Out of pocket costs for insulin include deductibles, copays or coinsurance. In most cases, people who use insulin will see lower out-of-pocket costs without any increased cost to the plan. (Cigna.com)


  • A federal court has approved Democratic Attorney General Josh Kaul’s request to withdraw Wisconsin from two lawsuits against the Affordable Care Act, handing a victory to Kaul and Gov. Tony Evers.

It’s the first time Kaul has removed the state from litigation after Republican lawmakers tried to limit his and Gov. Tony Evers’ power to do so during a lame-duck session in December. Both Kaul and Evers had campaigned on removing the state from litigation challenging the signature health care law.

Kaul submitted requests earlier this month to remove the state from the ACA lawsuits after a state judge’s order briefly gave him that authority. The order blocked laws enacted by Republicans in the December session that included limits on Kaul’s power to end — with the governor’s approval — the state’s role in litigation. A state appeals court later suspended the ruling. (Madison.com)

  • The U.S. Attorney’s Office announced on Thursday that three pharmaceutical companies –Jazz Pharmaceuticals, Lundbeck LLC, and Alexion Pharmaceuticals, Inc. – have agreed to pay a total of $122.6 million to resolve allegations that they violated the False Claims Act by paying kickbacks to Medicare and Civilian Health and Medical Program (ChampVA) patients through purportedly independent charitable foundations. “We are committed to ensuring that pharmaceutical companies do not use third-party foundations to pay kickbacks masking the high prices those companies charge for their drugs,” said United States Attorney Andrew E. Lelling. “This misconduct is widespread, and enforcement will continue until pharmaceutical companies stop circumventing the anti-kickback laws to artificially bolster high drug prices, all at the expense of American taxpayers.” (Justice.gov)

  • "Philip Esformes, a businessman who built an empire of healthcare facilities in Miami-Dade, was found guilty Friday of over 20 charges, including bribery and paying kickbacks, in a scheme to generate streams of patients for both his businesses. The wealthy Miami Beach executive managed his Miami-Dade chain of skilled-nursing and assisted-living facilities with an iron hand, with prosecutors arguing that he had billed close to $1 billion for questionable services that patients largely didn’t need or even receive. Esformes faced 26 charges overall and the 12-person jury, after four days of deliberation, came back with guilty verdicts in most of them in what was touted as the biggest Medicare fraud case in the country — in the reputed capital of such criminal activity, Miami. Jurors, however, did not reach a verdict on the main count — that Esformes had conspired to defraud the taxpayer-funded Medicare program." (MiamiHerald.com)


  • On Thursday, Amazon announced that the Alexa Skills Kit now enables select Covered Entities and their Business Associates, subject to the U.S. Health Insurance Portability and Accountability Act of 1996 (HIPAA), to build Alexa skills that transmit and receive protected health information as part of an invite-only program. Six new Alexa healthcare skills from industry-leading healthcare providers, payors, pharmacy benefit managers, and digital health coaching companies are now operating in their HIPAA-eligible environment. The current participating providers include Express Scripts, Cigna, and Boston Children's Hospital. In the future, Amazon expects to enable additional developers to take advantage of this capability. (Developer.Amazon.com)


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