About health insurance/insurers
CMS suspends all dispute resolution processes after latest No Surprises Act court loss “CMS said all federal independent dispute resolution processes are temporarily suspended in response to a Texas judge's latest ruling in a series of lawsuits challenging provisions of the No Surprises Act.
The agency said the suspension is taking place while necessary changes are being made to comply with the court's decision, according to an Aug. 25 notice on CMS' website. Disputing parties should continue to engage in open negotiation. “
Humana sues Biden administration over Medicare Advantage audit rule “Humana sued the federal government Friday, arguing that this year’s new rule to claw back overpayments from it and other Medicare Advantage insurers violates federal law due to its “shifting justifications and erroneous legal reasoning.”
‘The [Centers for Medicare and Medicaid Services] did not even try to offer an empirical or actuarial justification for its new audit methodology, relying instead on purely legal rationales — none of which withstand scrutiny,’ Humana said in the lawsuit.”
CMS suspects auto-renewal process at fault for wrongful Medicaid disenrollments “In a letter sent to all states, the Centers for Medicare & Medicaid Services (CMS) said it is requiring states to determine whether an eligibility systems issue is to blame for disenrolling adults and children from Medicaid or the Children’s Health Insurance Program (CHIP) despite many terminated individuals still being eligible for coverage.
CMS said in the letter that it believes eligibility systems, which utilize auto-renewals (otherwise known as ex parte renewals), have been programmed incorrectly and are conducting renewals at the family level but not at the individual level.”
Trends in Self-Insured Health Plans: Overall Trends Mask Differences by Firm Size “Key findings:
The percentage of private-sector establishments offering a self-insured health plan increased through 2016 but has since ebbed and flowed with no discernible long-term trend.
Recent trends have been more clearly defined when examined by firm size.
Since 2018, the percentages of small and medium-sized establishments offering at least one self-insured plan both increased. In contrast, the percentage of large establishments offering a self-insured plan has declined. The decline among large establishments occurred in most years since 2013.
Overall, the percentage of workers in self-insured plans has been bouncing around between 58 percent and 60 percent since 2010 but fell to 55 percent in 2022. This occurred despite the increase in self-insurance among small and medium-sized companies because of the drop in self-insurance among large firms.
Self-insurance varied substantially by state. Overall, the percentage of private-sector enrollees in self-insured plans varied from 33 percent in Hawaii to 70 percent in Ohio.
UnitedHealthcare's prior authorization cuts begin “The first wave of UnitedHealthcare's prior authorization cuts began Sept. 1.
In August, the payer released details of its plan to eliminate 20 percent of its current prior authorization. The cuts are coming across two waves. The second phase will begin Nov. 1. “
About hospitals and healthcare systems
Hospital Distress Worsens Amid Labor Scarcity and Inflation “More than 600, or about 30%, of all rural hospitals in the country are at risk of closing, according to the Center for Healthcare Quality and Payment Reform, a national policy center. As of August, 13 rural hospitals had shut their doors, exceeding seven and three in 2022 and 2021, respectively, according to the Cecil G. Sheps Center for Health Services Research, a unit of the University of North Carolina at Chapel Hill.
Rural hospitals number about 1,800 out of roughly 6,100 total in the U.S., according to the American Hospital Association.”
About pharma
Walgreens CEO steps down “Rosalind "Roz" Brewer — a former Starbucks and Sam's Club executive — has stepped down as CEO of Walgreens Boot Alliance after taking on the position in March 2021, the retail chain said Sept. 1.
In a statement, Walgreens said Ms. Brewer and the board of directors "mutually agreed" she would step down from the helm and as a board member, effective Aug. 31. Ms. Brewer became CEO at the start of the nation's COVID-19 vaccine rollout and led a team that put technology in place for the vaccine scheduling system.”
Wegovy costs $1.1m to prevent one heart attack, stroke, or cardiovascular death “Airfinity analysis on data from the Wegovy trial on cardiovascular outcomes reveals that even after a 65% rebate on the list price, it will cost $1.1m to prevent one heart attack, stroke or cardiovascular death.
The SELECT trial found that the drug semaglutide, sold under brand names Wegovy and Ozempic, resulted in a 20% reduction in major adverse cardiovascular events (MACE) in the enrolled population.”
About the public’s health
Overdose deaths from counterfeit drugs at historically high levels, and rising: CDC “The CDC report, conducted between July 2019 and December 2021, found that evidence of fake pill use and overdose deaths more than doubled during this period and tripled in the western United States.
In total, there were more than 54,000 overdose deaths, including 2,437 with evidence of counterfeit pill use. The study found that overdose deaths in connection with the use of counterfeit pills were often associated with people 35 and younger, those who are Hispanic or Latino and those with a history of prescription drug misuse.
The study found that more than half of the deaths with evidence of fake pill use were related to counterfeit oxycodone or with counterfeit alprazolam, which is more commonly sold under the brand name Xanax. The study notes that the counterfeit pills are made to look like the legitimate pharmaceutical pills.”
FDA says it will finalize ban on menthol tobacco products ‘in coming months’ “In April 2022, when the FDA initially announced that it was going to ban the popular flavor, it set a deadline of August 2023 to work out the details. That deadline is still listed online, but a spokesperson said it will instead complete work on the rule ‘in the coming months.’”
About healthcare personnel
The most dangerous places to work in healthcare FYI
About healthcare finance
Amgen settles with FTC on Horizon merger “Amgen announced Friday that it has reached a consent order agreement with the US Federal Trade Commission (FTC) that resolves an administrative lawsuit by the antitrust regulator and clears a path forward to closing its planned $27.8-billion takeout of Horizon Therapeutics. The companies anticipate being able to close the acquisition early in the fourth quarter.
Amgen first moved to buy Horizon last December in an effort to gain access to the latter's rare disease assets, including its thyroid eye disease therapy Tepezza (teprotumumab) and the chronic refractory gout treatment Krystexxa (pegloticase). However, the FTC sought to block the merger on grounds that it would stifle competition.”