CMS Responds To Pharma Offers In Medicare Drug Price Negotiations
Negotiations over the prices of 10 prescriptions drugs proceed to the next phase, as the Centers for Medicare and Medicaid Services say they have rejected initial price offers from manufacturers, Politico reports. Each company will have three chances to meet with CMS during the negotiations, with final prices to be announced on Aug. 1.
Politico:
CMS Rejects Drugmaker Price Offers, Kick-Starting Medicare Talks
CMS said Tuesday it shot down drugmakers’ price offers for 10 pharmaceuticals subject to Medicare price negotiations, kicking off talks expected to stretch through the summer. The agency’s decision is the latest development in a negotiation process created by the Inflation Reduction Act. Officials touted the prospect of savings for those on Medicare, but the final prices won’t take effect until 2026. (King, 4/2)
Reuters:
US Takes Next Step In Medicare Drug Price Negotiations With Pharma Companies
The agency overseeing Medicare, the Centers for Medicare and Medicaid Services (CMS), picked the first 10 drugs for negotiation in August and sent its initial price offers in February. The companies involved had until March 1 to respond and all did so. Each company can meet with CMS up to three times for further negotiations before a final price is announced on Aug. 1. The negotiated prices will come into effect in 2026. (4/2)
In other news —
CNBC:
Health Insurer Stocks Slide As Medicare Advantage Rates Disappoint
Shares of U.S. health insurers fell Tuesday after the Biden administration didn’t boost payments for private Medicare plans as much as the insurance industry and investors had hoped. (Constantino, 4/2)
Modern Healthcare:
CMS Finalizes Network Rules For Exchange Plans
The Centers for Medicare and Medicaid Services made some tweaks to the health insurance exchanges in a final rule published Tuesday. The regulation establishes network adequacy standards based on the time and distance patients have to travel for in-network care beginning in 2026 and aligns the annual open enrollment period for state-based exchanges with the federal sign-up campaign. The final rule is consistent with what the agency proposed in November. (Berryman, 4/2)
The Wall Street Journal:
Medicare Keeps Getting Tougher For Health Insurers
Medicare Advantage plans had already been facing an unusual rise in medical costs. Now, the payments they get from the government also are squeezing them from the other side. Late Monday, the Centers for Medicare and Medicaid Services announced it would leave an earlier payment proposal unchanged, which came as a big disappointment to investors who had expected an increase. On Tuesday morning, insurance giants were tumbling, with Humana declining nearly 10%. Centene and UnitedHealth were down by less. (Wainer, 4/2)
Bloomberg Law:
Rural Hospitals Seek Help As Private Medicare Patients Increase
Rapid enrollment growth in Medicare managed care plans is creating another layer of economic uncertainty for beleaguered rural hospitals. The number of rural beneficiaries enrolled in private Medicare Advantage plans jumped nearly 48%, from 6.3 million to 9.2 million, between 2019 and 2023, according to health consulting firm Chartis. By 2023, 44% of rural beneficiaries were enrolled in MA plans, according to the Medicare Payment Advisory Commission. But rural hospitals say MA plans often pay less than traditional Medicare, don’t cover as many services, and are more likely to deny or delay coverage through prior authorization. (Pugh, 4/3)
Also —
MPR News:
‘Overdue For Action’: Pharmacists Press For Financial Help, Changes To Prevent Closures
Independent pharmacists on Tuesday urged lawmakers to take action to boost their Medicaid reimbursement rates to help them stay afloat financially. Without a lifeline, a group representing pharmacists said some around the state would have to close their doors in coming months. The request comes as more independent pharmacies face financial strains. Roughly 34 percent of independent pharmacies closed between 2018 and 2023, compared to 20 percent of retail pharmacy chains. (Ferguson, 4/2)
Crain’s Chicago Business:
Walgreens Medicare-Medicaid Whistleblower Lawsuit Moves Forward
A federal judge has given the green light for a whistleblower lawsuit contending that Walgreens violated U.S. and Illinois false claims statutes by steering Medicare and Medicaid patients to its own pharmacy by waiving co-pays. In a case that’s been kicked around for about a decade after several amendments and the U.S. and Illinois governments trying to hop aboard, Judge John F. Kness, of the U.S. District Court for the Northern District of Illinois ruled on March 29 that the complaint brought by two former Walgreens pharmacy technicians could continue. (Asplund, 4/2)
NPR:
Mental Health Care Is Hard To Find, Especially If You Have Medicare Or Medicaid
With rates of suicide and opioid deaths rising in the past decade and children’s mental health declared a national emergency, the United States faces an unprecedented mental health crisis. But access to mental health care for a significant portion of Americans — including some of the most vulnerable populations — is extremely limited, according to a new government report released Wednesday. The report … finds that Medicare and Medicaid have a dire shortage of mental health care providers. (Chatterjee, 4/3)
White House Plan To Fix Drug Supplies Leverages Hospital Medicare Payments
The plan will base Medicare pay to hospitals on how well the facilities’ business practices aim at avoiding drug shortages. Meanwhile, supplies of Eli Lilly’s diabetes drug Mounjaro are in short supply through April, and ADHD meds shortages drag on.
Stat:
White House Offers New Plan To Address Drug Shortages
The White House at long last published a plan to stem drug shortages, and it involves basing Medicare pay to hospitals on whether hospitals adopt business practices that avoid shortages. The White House formed a task force at the beginning of 2023 to deal with the issue of persistent drug shortages, including cancer drugs. As of late last summer, lawmakers working on drug shortage legislation hadn’t spoken to the task force and didn’t know who was in charge of it. (Wilkerson, 4/2)
Reuters:
Some Doses Of Lilly’s Mounjaro In Tight Supply Through April, US FDA Says
Four doses of Eli Lilly’s diabetes drug Mounjaro would remain in tight supply through 2024 due to soaring demand, the U.S. Food and Drug Administration’s website showed. The regulator noted limited availability of 7.5, 10, 12.5, and 15 milligram doses through April, while lower doses were listed as “available”. The FDA had previously said that three doses would have limited availability through early March. (4/2)
Axios:
More Americans Forgoing ADHD Meds As Shortages Drag On
Shortages of commonly prescribed drugs for attention deficit hyperactivity disorder have stretched on for nearly 18 months, with no clear end in sight for many Americans who’ve found it difficult if not impossible to get the treatments. Why it matters: As demand for stimulants like Adderall and Vyvanse soared, the fill rate for such prescriptions has dropped more than 10% in two years, according to a new analysis from health analytics firm Truveta. (Reed, 4/3)
In other administration news —
Reuters:
US FDA Approves Vanda’s Drug For Treatment Of Bipolar Disorder
The U.S. FDA approved Vanda Pharmaceuticals’ drug to treat manic and mixed episodes associated with a type of bipolar disorder, the company said on Tuesday, marking the second approval for the treatment. Shares of the Washington, D.C.-based company jumped 16% after the bell. Fanapt, which was initially approved in 2009 as a treatment for schizophrenia, faces a potential loss of exclusivity in 2027. (4/2)
Reuters:
Abbott’s Heart Valve Repair Device Gains US FDA Approval
Abbott Laboratories, opens new tab said on Tuesday the U.S. FDA has approved its heart valve repair device for patients with a potentially fatal heart disease, just months after rival Edwards Lifesciences, opens new tab received the regulator’s nod for its device. The Abbott device, TriClip, aims to treat tricuspid regurgitation (TR), which occurs when the valve separating the right lower chamber of the heart from the right upper does not close properly, causing blood to flow backwards. (Singh, 4/2)
In other news —
Modern Healthcare:
Joint Commission Considers Stronger Suicide Prevention Standards
The Joint Commission is considering whether its hospital accreditation standards should include more requirements tied to suicide prevention efforts.The accrediting body already has standards intended to prevent suicide among patients treated for behavioral health conditions once they are discharged. However, there are no standards for other patients related to detailed safety planning, including how individuals are transitioned to outpatient care providers and how access to lethal weapons is restricted. (Devereaux, 4/2)
CIDRAP:
Alaskapox Virus Renamed As Borealpox Virus
The Alaska Department of Health (ADH) announced that it has been consulting with the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to change the name of the Alaskapox virus to “borealpox virus,” with the renaming taking effect with the start of April. ADH said the name references the ecosystem where the virus was found in humans and small animal reservoirs. (Schnirring, 4/2)
The Hill:
COVID Subcommittee Chair Asks Top Science Journal Editors To Testify On Relationship With Federal Government
Rep. Brad Wenstrup (R-Ohio), chair of the House Select Subcommittee on the Coronavirus Pandemic, issued letters to the editors of three major science journals on Tuesday, asking them to testify on the relationship between their publications and the federal government. … In his letters, Wenstrup stated that the hearing would be to examine “whether these journals granted the federal government inappropriate access into the scientific review or publishing process.” (Choi, 4/2)
Reuters:
Lawsuit Demands Menthol Cigarette Ban Following White House Delays
The U.S. government was sued on Tuesday by anti-smoking groups that want a ban on menthol cigarettes and blame the Biden administration for delaying it. … The U.S. Food and Drug Administration in April 2022 had proposed banning menthol. Health officials originally planned to publish a final rule by last August, and after missing that deadline pushed back the target date to last month. (Stempel, 4/2)
Reuters:
Parents Lose Bid To Revive Claims They Overpaid For Abbott Formula Pre-Recall
A federal appeals court on Tuesday upheld the dismissal of a proposed class action by parents who say they overpaid for Abbott Laboratories’ (ABT.N) baby formula before one of its plants was shuttered for unsanitary conditions. The parents had urged the Chicago-based 7th U.S. Circuit Court of Appeals to conclude they had legal standing to sue Abbott, arguing that they would not have paid the purchase price for Similac and other Abbott brands if they had known of the safety risks that led to the plant shutdown and a subsequent recall. (Raymond, 4/2)
Also —
KFF Health News:
Attacks On Emergency Room Workers Prompt Debate Over Tougher Penalties
Patients hurl verbal abuse at Michelle Ravera every day in the emergency room. Physical violence is less common, she said, but has become a growing threat. Ravera, an ER nurse at Sutter Medical Center in Sacramento, recalled an incident in which an agitated patient wanted to leave. “Without any warning he just reached up, grabbed my glasses, and punched me in the face,” said Ravera, 54. “And then he was getting ready to attack another patient in the room.” (Parekh, 4/3)
