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Pharmacy benefit managers have curtailed in-person audits of pharmacy claims during the pandemic, switching to virtual audits done by computer. That has markedly increased the number of claims they can review — and the chances for payment denials — squeezing pharmacies and bringing in more cash for the benefit companies.
Covid is back with a vengeance, with some people clamoring for booster shots while others harden their resistance to getting vaccinated at all. Meanwhile, the Food and Drug Administration is pushing hard on drugmaker Pfizer’s request to upgrade the emergency authorization for its vaccine and give it final approval. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, for “extra credit,” the panelists suggest their favorite health policy stories of the week they think you should read, too.
The Medicare rule, designed by the Trump administration to take money away from drug industry brokers and provide refunds to patients, has not been implemented. But budget analysts say if it were, it would cost the government money. So senators are pushing the rule aside and claiming to save billions of dollars, which they want to use instead on new projects.
Health plans’ coverage of the medication, branded as Wegovy — which has a $1,300-a-month price tag — is not a sure thing.
Pharmaceutical companies routinely cover the cost of patient copays for expensive drugs under private insurance. A federal judge could make the practice legal for millions on Medicare as well.
Missouri is the last state to create a monitoring program to help spot the misuse of prescription drugs. But some public health experts warn that the nation’s programs are forcing people addicted to opioids to seek deadlier street options.
KHN and California Healthline staff made the rounds on national and local media this week to discuss their stories. Here’s a collection of their appearances.
The makers of Aduhelm, a drug approved last month despite concerns raised by experts about its effectiveness, have launched a website and ads designed to urge people who are worried about their memory to ask doctors about testing. But some health advocates say it is misleading because some memory loss with aging is normal.
In today’s pharmaceutical universe, a simple “safe and effective” determination by the Food and Drug Administration to approve a drug can be manipulated to sell products of questionable value. And drugmakers can profit handsomely.
Sen. Ron Wyden (D-Ore.), who is helping to negotiate the health care spending framework for the Democrats' budget plan, said lawmakers may have to settle for very basic versions of programs deployed in the package. But the key, he added, is to get the "architecture of these changes, bold changes," started and show people what is possible.
The July 9 directive addresses the importation of prescription drugs and broader efforts to reduce the high cost of medicines.
KHN and California Healthline staff made the rounds on national and local media this week to discuss their stories. Here’s a collection of their appearances.
Democrats in Congress reached a tentative agreement to press ahead on a partisan bill that would dramatically expand health benefits for people on Medicare, those who buy their own insurance and individuals who have been shut out of coverage in states that didn’t expand Medicaid. Meanwhile, controversy continues to rage over whether vaccinated Americans will need a booster to protect against covid-19 variants, and who will pay for a new drug to treat Alzheimer’s disease. Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews KHN’s Rae Ellen Bichell, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a mother and daughter who fought an enormous emergency room bill.
The plan from high-wire negotiations would affect five key areas of health, but there will be further tense negotiations among Democratic lawmakers about specifics of the $3.5 trillion in funding. And all Senate Democrats will need to be behind the plan, because Republicans oppose it.
When patients with common terminal illnesses such as cancer seek permission for compassionate use of therapies in the testing stage, their requests often are approved. But those with more unusual illnesses say drug companies are rarely willing to provide access.
In an interview for KHN’s “What the Health?” podcast, HHS Secretary Xavier Becerra says the administration is eager for Congress to make changes to Medicare that will provide more benefits and make more older adults eligible for the program. He also said a priority will be making permanent the enhanced premium subsidies for Affordable Care Act marketplace plans.
Health and Human Services Secretary Xavier Becerra is the special guest for this bonus episode of KHN’s “What the Health?” podcast. He and host Julie Rovner discuss a breadth of topics the secretary oversees, including covid-19, prescription drug prices, Medicare, Medicaid and the Affordable Care Act.
It could take years for follow-up studies to prove Aduhelm slows the disease — or doesn’t. Meanwhile, its maker will profit.
The pharmaceutical industry argues that large profits are needed to fund extensive research and innovation. But Democrats on the House Oversight and Reform Committee, seeking to bolster their effort to let Medicare negotiate drug prices, say major drug companies plow more of their billions in earnings back into propping up their stock and enriching executives and shareholders.
The potential benefits of Aduhelm are small, its effectiveness is not certain, and even the FDA Thursday shifted its guidance on who should get the drug. But physicians are dealing with an onslaught of interest from patients and their families, and figuring out which patients are best positioned to be helped by the drug will be difficult.
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