Today's News and Commentary

About insurance

Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey: The Kaiser Family Foundation just released its 17th annual report on Medicaid and the Children’s Health Insurance Program (CHIP) eligibility, enrollment, renewal, and cost sharing policies. It is a great update and worth reading- if only to get overall messages from the graphics.

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Doughnut Hole Is Gone, But Medicare’s Uncapped Drug Costs Still Bite Into Budgets: This article is a reminder that there is no cap on Medicare Part D expenses- even for those who purchase an insurance policy. At the highest payment levels, beneficiaries are still responsible for 5% of payments.

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Trent Haywood reflects on the BCBS Institute's first year: One year ago, the Blue Cross/Blue Shield Association set up the BCBS institute to develop partnerships and solutions addressing social determinants of health. This article is an interview with the institute’s president, Dr. Haywood. It is an interesting approach to addressing healthcare through the Association’s members.

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White House to send 'principles' for Obamacare replacement plan to Capitol Hill: This article updates the back and forth between the White House and Republican members of Congress about the responsibility for crafting its party’s health care message. The President first claimed that healthcare would be a Republican issue in the next election, but left the details to Congress. Then some members of Congress were said to be gathering to work on it. Saturday, the Washington Post reported “Republicans have no intention of heeding President Trump’s urgent demands for a new health-care plan to replace the Affordable Care Act.” Now, Acting White House chief of staff Mick Mulvaney said the White House would be sending guidance to Congress on how to replace the ACA. Stay tuned for the next installment of this highly coordinated effort.

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Physicians score overwhelming victory in bid to fix prior authorization: As recently reported, The AMA documented widespread problems with physicians getting timely prior authorization (PA) responses from health plans. In the first instance of a law to correct these issues, Kentucky has passed legislation mandating certain changes to insurance company practices. Under the measure:  

—Physicians will receive responses on PA requests within 24 hours for urgent services and within five days for non-urgent services. 

—Prescriptions for chronic-condition maintenance drugs will be valid for one year, and any change in dosage during this period will be covered.   

—Insurers’ PA procedures will be posted online as well as a complete list of services requiring PA. 

—Insurer PA reviewers will be licensed physicians and, when possible, of the same specialty as the requesting physician.  

—Physicians and other clinicians will be able to electronically request and transmit PAs.

The new law takes effect Jan. 1, 2020.

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About pharma

FDA Raises Impurity Threshold to Address Losartan Shortage: Many manufacturers of the antihypertensive drug losartan had their product contaminated with the potentially cancer causing substance N-Nitroso-N-methyl-4-aminobutryic acid. Withdrawal from the market of many sources  of this drug has caused a shortage. Now the FDA says it will allow a higher content of this impurity as a way to address the shortage. Losartan is an angiotensin receptor blocking agent (ARB). There are many other drugs in this class that can be substituted. However, manufacturers of two of the substitutes, irbesartan and valsartan, have also had their products recalled. One wonders if it is really necessary to “raise the impurity threshold” or are there other alternatives, like using ACE inhibitors.

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Delivering Better Health and Affordability: Express Scripts issued a report on its value-based system called SafeGuardRx®. The report says the program saved clients more than $2.4billion and slowed drug cost growth. Specific disease category initiatives (like diabetes) are also explained.

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Biosimilar Groups Seek ‘Structural’ Changes in U.S. Market: According to this article, the US needs to step up its efforts to facilitate development, approval and marketing of biosimilars. “Europeans now make up 90 percent of world biosimilar sales".”

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First TV drug ad featuring list price debuts today: This article from Friday features the first U.S. direct-to-consumer TV drug ad to disclose price: J&J’s Xarelto.

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About healthcare quality and safety

2019 Top 10 Patient Safety Concerns: each year ECRI publishes its top 10 patient safety concerns. Here is this year’s list:
1. Diagnostic Stewardship and Test Result Management Using EHRs
2. Antimicrobial Stewardship in Physician Practices and Aging Services
3. Burnout and Its Impact on Patient Safety
4. Patient Safety Concerns Involving Mobile Health
5. Reducing Discomfort with Behavioral Health
6. Detecting Changes in a Patient’s Condition
7. Developing and Maintaining Skills
8. Early Recognition of Sepsis across the Continuum
9. Infections from Peripherally Inserted IV Lines
10. Standardizing Safety Efforts across Large Health Systems

Read the report (May need to register at

Appellate court case puts peer-review protections in danger: Peer-review documents have been shielded from discovery in malpractice trials. The reason for this confidentiality is to enhance physician compliance with quality-enhancing activities. This process has been put in danger by a recent court case in Michigan which has been appealed.

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