Source Insights
Do Bundled Payments Have a Future in Medicare?
Katie Gudiksen, Senior Health Policy Researcher December 7, 2017
In an op-ed written for the Wall Street Journal on September 19, 2017, Seema Verma, the new administrator for the Centers for Medicare &|Medicaid Services (CMS), announced a “new direction” initiative for the Center for Medicare and Medicaid Innovation (CMMI).[1] The Affordable Care Act (ACA) created the CMMI to design and evaluate new payment models designed to either lower spending without reducing the quality of care, or improve the quality of care without increasing spending.[2] The CMMI established payment initiatives that used Medicare to test and implement payment reforms that …
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Has the Problem of Increasing Drug Prices Really Passed?
Katie Gudiksen, Senior Health Policy Researcher November 22, 2017
The rate of increase in spending on pharmaceuticals is declining, according to a Quintiles-IMS Health report from May of 2017.[1] In 2016, the rate of increase in spending on pharmaceuticals was only 4.8% on a net basis (i.e. including rebates and discounts) – less than half that in 2014 and 2015, although it remains much higher than inflation. Express Scripts, one of the largest Pharmacy Benefit Managers (PBMs) in the U.S., reports that in their employer-based plans, per-person spending on prescription drugs increased just 3.8%, much lower than previous years.[2] …
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Healthcare Companies with a Conscience: How Benefit Corporations Can Reduce Healthcare Costs
Source Fellow November 9, 2017
By: Katie Beyer, Student Fellow As healthcare costs continue to rise from almost every angle, quality healthcare and treatment often come with a lofty price tag. Survival of private healthcare providers is contingent upon optimizing profits, such that a company’s motivation is driven by shareholder value instead of commitment to social responsibility. Good health at a fair price is often not the primary corporate goal for healthcare companies, but what if it could be? A benefit corporation is a new legal tool currently available in 33 states and allows private companies …
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The End of CSRs: Trump Eliminates “Bailouts” While Others Seek a Solution
Source Fellow October 30, 2017
By: Briana Moller, Student Fellow Trump Administration Has Eliminated CSR Payments On October 11, 2017, in a memo to the Department of Treasury and the Department of Health and Human Services (HHS), Attorney General Jeff Sessions provided his legal opinion that Cost Sharing Reduction (CSR) payments were unlawful. CSR payments reimburse insurance companies for losses in deductibles, copays, and coinsurance payments owed by lower income individuals in health plans on the Affordable Care Act (ACA) exchanges. The following day, Eric Hagan, the acting Secretary of HHS, announced that CSR payments …
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Can Policies at the FDA Help Curb Rising Drug Prices?
Katie Gudiksen, Senior Health Policy Researcher October 20, 2017
In a recent blog post, Scott Gottlieb, the Commissioner of the Food and Drug Administration (FDA), signaled that the FDA would take a more proactive approach to approving drugs to attempt to increase competition in the pharmaceutical market. In the post, Gottlieb acknowledged that the “FDA doesn’t control drug pricing, [but] our policies do affect competition in the market. This is the nexus of our current efforts on drug pricing.” Details of the Announcement In his blog post, Gottlieb describes two draft guidances to aid in the approval of generic …
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Governor Brown Signs Groundbreaking Drug Price Transparency Bill
Katie Gudiksen, Senior Health Policy Researcher October 13, 2017
What does the California Drug Transparency Bill (S.B. 17) Actually Do? On Monday, October 9, Governor Jerry Brown signed S.B. 17, the California Drug Transparency Bill into law. Brown and the bill’s supporters said the new California law should prompt action in other states and could be used by Congress as a blueprint to help rein in rising drug costs. The Mercury News called the bill “the nation’s most comprehensive law aimed at shining a light on prescription drug prices.” The law becomes effective on Jan 1, 2018 and seeks …
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Bailout or Bust? How CSR Payments Are in a Precarious State
Source Fellow September 29, 2017
By: Briana Moller, Student Fellow What’s Happened Earlier this year, President Trump began discussing the idea of eliminating cost sharing reduction (“CSR”) payments to insurance companies. (1) CSR payments are reimbursements the federal government provides to insurance companies that provide discounts to enrollees with incomes between 100 and 250% of the poverty line. (2) In a recent tweet, the President referred to CSR payments as “bailouts” to insurance companies and threatened to end these payments “very soon!” So what does this all mean? If President Trump eliminates CSR payments, insurance …
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Allergan Makes Deal with Mohawk Nation to Avoid Patent Review Process
Katie Gudiksen, Senior Health Policy Researcher September 13, 2017
The tricks pharma companies use to protect endangered patents took an unexpected turn on Friday when Allergan transferred the rights to all of its patent on Restasis, a drug to treat chronic dry-eye, to the Saint Regis Mohawk tribe. The tribe will then grant Allergan exclusive licenses to the transferred patents. In exchange, the tribe will receive a $13.75 million upfront cash payment and up to $15 million in annual royalties from Restasis sales. Allergan was facing both a federal lawsuit filed in Texas challenging the Restasis patents and an …
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Three Things to Know About the Competitive Health Insurance Reform Act
Anna Zaret, Managing Editor April 5, 2017
On March 22nd, House Resolution 372, known as the Competitive Health Insurance Reform Act, passed in the House by a vote of 416 to 7. The bill repeals antitrust exemptions for health insurers created by the McCarran-Ferguson Act of 1945 (15 U.S.C. §§ 1011-1015) (“McCarran-Ferguson”). Unfortunately, despite bipartisan support for this legislation, it is unlikely to significantly improve competition in health insurance markets. The legislation is unlikely to improve health insurance market concentration, or create a robust market for health insurance sales across state lines, despite GOP hopes. The legislation …
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California Regulators Approve Health Net/Centene Deal With Conditions
Elizabeth Nicholson, Research Fellow March 23, 2016
UPDATE: March 23, 2016: California state regulators approved the Centene and Health Net merger—subject to strong conditions. Centene announced that it received approval from the California Department of Managed Health Care (“DMHC”), on March 22, 2016, and approval from the California Department of Insurance (“CDI”), on March 23, 2016. Both state agencies placed significant—and expensive—conditions on the merger. DMHC provided an extensive list of undertakings. In addition to typical closing requirements, DMHC is requiring Centene to satisfy unique conditions. The San Francisco Business Times reported that DMHC’s conditions carry a “total …
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