Today's News and Commentary

About insurance

Federal judge strikes down Medicaid work requirements in Kentucky, Arkansas: This news is today’s top story. The title is self-explanatory. The reason the judge gave for the decision was that the work requirement was not in the best interest of Medicaid’s purpose. However, he did not rule out other methods to save the program money.

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CMS Should Assess Documentation Necessary to Identify Improper Payments: The GAO reported that in fiscal year 2017, “Medicare FFS [fee for service] had an estimated $23.2 billion in improper payments due to insufficient documentation, while Medicaid FFS had $4.3 billion—accounting for most of the programs’ estimated FFS medical review improper payments.” The Medicare improper payments, while large, have been declining since a peak in 2014.

What if a private insurance company made such an announcement? Imagine what the number would be if we had a single payer system, i.e., the federal government.

“GAO is making four recommendations to CMS, including that CMS assess and ensure the effectiveness of Medicare and Medicaid documentation requirements, and that CMS take steps to ensure Medicaid’s medical reviews effectively address causes of improper payments and result in appropriate corrective actions. CMS concurred with three recommendations, but did not concur with the recommendation on Medicaid medical reviews. GAO maintains that this recommendation is valid as discussed in this report.”

Read the full report

About pharma

Louisiana has picked its 'Netflix' hepatitis C partner: Gilead's new generics unit: Continuing reporting on this story, Louisiana has chosen Gilead to receive fixed, global payments for however many state-funded patients need Hepatitis C medication.

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Walgreens to sell CBD products in 1,500 stores: Cannabidiol (CBD) is the “non-high” component of marijuana that claims to help anxiety and nausea. In addition to Walgreens, CVS started to offer CBD products in eight states earlier this month.

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Prevalence and Severity of Rationing During Drug ShortagesA National Survey of Health System Pharmacists: This research quantifies the problem of hospitals’ drug shortages. Some major takeaways: “All respondents [719] reported experiencing drug shortages in the preceding year and 498 respondents (69.2%) reported more than 50 shortages… Most respondents (664 [92.4%]) reported an average of less than 1 month from notification to active shortage…More than one-third of respondents (247 [34.4%]) reported an episode of rationing within the past year. Rationing occurred more frequently at academic hospitals …and academically affiliated hospitals…”

Read the article (Subscription required to full article from JAMA Internal Medicine)

Want to Reduce Opioid Deaths? Get People the Medications They Need: This NY Times editorial explains that while we want to make opioid addiction treatment more prevalent and accessible, the federal government has restricted use of approved medications.

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Pharmacy Benefit Managers: Practices, Controversies, and What Lies Ahead:As previously reported, one initiative being considered to lower drug prices is changing the drug rebate system- either eliminating the practice or giving rebates to patients instead of PBMs and payers. This article from the Commonwealth Fund is a great summary of the rebate practices and issues around changing where the rebates will go. Bottom line is it would help if we changed the rebate practices but need to do much more to control high pharma costs.

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About healthcare IT

CMS offers up to $1.6M in AI challenge for better healthcare prediction tools: In partnership with the American Academy of Family Physicians and the Laura and John Arnold Foundation, CMS announced it will fund projects up to $1.65 million each for its new CMS Artificial Intelligence Health Outcomes Challenge.

Read more about the challenge