About health insurance/insurers
2023 Medical Loss Ratio Rebates “We find that insurers estimate they will issue a total of about $1.1 billion in MLR rebates across all commercial markets in 2023…”
Senate passes resolution to overturn Biden administration rule that does not penalize immigrants for receiving government benefits “The Senate passed a resolution Wednesday to stop a Biden administration immigration rule that eliminates potential hurdles for immigrants using some public benefits and trying to obtain legal status, known as ‘public charge.’
It passed 50-47, with two Democratic senators crossing party lines – Joe Manchin of West Virginia and Jon Tester of Montana – both of whom are up for reelection.
The resolution is an effort to return to the Trump administration policy, which made it more difficult for immigrants to obtain legal status if they use public benefits.
It is a joint resolution, meaning it would need to pass in the House as well before it would reach President Joe Biden’s desk. The House has not yet voted on it.”
It is likely that the Biden administration would issue a veto if the resolution also passes in the House.”
About hospitals and healthcare systems
Hospitals' revenues continue to decline due to increasing delays and denials by commercial insurers “Hospitals and health systems hoping to financially rebound from the pandemic-induced downturn have found themselves struggling to collect payments for services rendered, especially among commercial payors. A new Crowe report, "Time for a Commercial Break," analyzes information pulled by Crowe Revenue Cycle Analytics software and reveals when it comes to denial rates, accounts receivable, bad debt and takebacks, healthcare providers are having a much more favorable experience working with traditional Medicare over commercial insurers….
Traditional Medicare also fared better across prior authorization/precertification, initial and request for information (RFI) denial rates. Through the first quarter of 2023:
Initial prior authorization/precertification denial rate for inpatient claims for commercial payors was 3.2% compared with 0.2% for Medicare.
Commercial payors initially denied 15.1% of inpatient and outpatient claims for any reason compared with 3.9% for Medicare.
The RFI denial rate for inpatient and outpatient claims submitted by providers to commercial payors was 4.8%, 12 times Medicare's denial rate of 0.4%.”
About pharma
FTC expands probe into pharmacy benefit managers to GPOs “The Federal Trade Commission (FTC) is expanding its probe into pharmacy benefit managers by issuing compulsory orders to two group purchasing organizations that negotiate rebates on behalf of PBMs.
The FTC said late Wednesday that the orders will require Zinc Health Services and Ascent Health Services to provide key details and information on their business practices. Last summer, the agency sent similar orders to the six largest PBMs in the country: CVS Caremark, Express Scripts, Optum Rx, Humana Pharmacy Solutions, Prime Therapeutics and MedImpact Healthcare Systems.”
Supreme Court rules against Amgen in closely watched case over scope of patent claims “n a case that had the pharmaceutical industry on edge, the U.S. Supreme Court upheld a lower court ruling that Amgen failed to disclose sufficient information about patent claims for a best-selling drug.
The court ruled unanimously that Amgen failed to provide what amounts to a roadmap for others to recreate the claims made in two patents for Repatha, a cholesterol medication. A federal appeals court had previously invalidated the patents after deciding that Amgen filed an overly expansive patent claim that failed to disclose enough information so someone else can make the same product.”
Walgreens to pay San Francisco $230M for its role in opioid epidemic “Walgreens has agreed to pay $230 million to San Francisco for its role in the city’s opioid epidemic following last year’s landmark trial that found the pharmacy chain liable for not performing proper screenings.”
About health technology
New Biden science agency ARPA-H launches first program, targeting bone regrowth “The Advanced Research Projects Agency for Health, launched a little more than a year ago, announced Thursday that its first official program would target bone and joint damage from osteoarthritis, a condition affecting more than 32 million Americans.”