Read today’s Kaiser Health News
In other news:
Judge partially blocks Trump administration from enforcing funding ban against Planned Parenthood:US District Judge Indira Talwani partially granted Planned Parenthood’s request for a preliminary injunction while its lawsuit against the administration plays out. The order does not apply to all Planned Parenthood members.
The Trump administration will not be allowed to enforce the funding ban against the Planned Parenthood members who cannot provide abortions because of state abortion bans, or who received less than $800,000 in Medicaid reimbursements in 2023…
About health insurance/insurers
Humana to reduce about one-third of prior authorization requirements: Humana said on Tuesday it would eliminate about one-third of prior authorizations for outpatient services by next year, the latest insurer to address the tedious paperwork process that has been a pain point for patients and providers.
The company will remove the authorization requirement for diagnostic services across colonoscopies and transthoracic echocardiograms and select CT scans and MRIs by January 1, 2026.
About pharma
Lawmakers introduce bill to end drugmaker limits on 340B discounts: The Pharmaceutical Access to Invest in Essential, Needed Treatments & Support Act, introduced by Rep. Doris Matsui (D-Calif.) and Sen. Peter Welch (D-Vt.) would require drugmakers to provide 340B discounts to eligible hospitals that use contract pharmacies to dispense medications, according to a July 22 press release from 340B Health shared with Becker’s.
The bill would also ban drugmakers from placing conditions on those discounts and establish civil monetary penalties for violations, the release said.
Federal judge halts key parts of Iowa PBM law: 3 notes: A federal judge has temporarily blocked portions of Iowa’s pharmacy benefit manager law, Senate File 383, ruling that several provisions likely conflict with federal law, the Des Moines Register reported July 22.
FCA Draws Heavy Constitutional Fire After $1.6B J&J Verdict: The 10-figure judgment — the largest in FCA history, according to J&J — was the result of a trial last year in New Jersey federal court. There, a jury found that the J&J division defrauded Medicare and Medicaid by marketing HIV drugs Prezista and Intelence for unapproved uses.
Sanofi touts real-world Beyfortus data as Merck & Co.'s RSV rival enters field: Among infants who received Beyfortus, there were far fewer episodes of RSV lower respiratory tract disease (LRTD) — 35 compared with 462 in those who did not get the antibody. Overall, Beyfortus was 87.2% effective at preventing RSV-related lung disease, 98% effective at preventing cases that led to hospitalisation, and 71% effective against lab-confirmed RSV. Infants who were immunised but still got sick also had fewer medical visits and were much less likely to be hospitalised than those who weren't protected.
Comment: A good reason to allow RSV immunizations to continue.
2024 Gross-to-Net Realities at 9 Top Drugmakers: A New Era of Market Access: Drug Channels’ annual update on drug pricing trends at the largest pharmaceutical manufacturers.
[D]ata highlight divergent trends reshaping the gross-to-net bubble:
Rebates, discounts, and other fees reduced the selling prices of brand-name drugs at the biggest drugmakers to less than half of their list prices.
When accounting for all list price reductions, average brand-name drug prices declined at four manufacturers and increased at five others.
Gross-to-net difference in price changes ranged from −12.8% to +4.2%, reflecting significant differences in the manufacturers’ portfolio mix and pricing strategies.