Opting Out of Medicaid Cuts
Certain states may have the opportunity to opt out of Medicaid cuts under the Senate’s new bill to repeal the Affordable Care Act. According to Politico, Alaska, Wyoming, South Dakota, North Dakota, and Montana may be able to delay the new Medicaid financing system in the bill based on their low-density populations. The rest of the states would be moved to the bill’s block grant payment system. The opportunity to opt out would expire in 2026. Alaska’s governor has come out against the bill, while Senator Lisa Murkowski, who voted against previous repeal bills, is currently undecided.
Amazon Is in Talks With PBMs
There have been rumors for a while that Amazon might be looking to get into the pharmaceutical business. Now there are reports that the retail giant is in talks with mid-size pharmacy benefit managers (PBMs) to set up contracts, according to FiercePharma. Amazon could also decide to become an online pharmacy, an integrated PBM, or a distributor for pharmacies. Amazon’s entry into the field could take 18 to 24 months and would significantly shake up the drug business.
Safety Net Hospital Payments at Risk
Hospitals are currently reimbursed for some of the costs they incur from taking care of uninsured patients or those who cannot afford their medical bills through a federal program that is now at risk of expiring. The Disproportionate Share Hospitals payments offset some of the uncompensated care hospitals provide, but a payment cut is slated for October 1, reported STAT. If Congress doesn’t act, a total of $43 billion in payment cuts will start to take effect. Safety net hospitals, which care for some of the most vulnerable populations, will be hit the hardest.
CMS' 340B Repayment Proposal May Harm Vulnerable Hospitals, Reward Those With Higher Revenues
April 26th 2024The 340B hospitals not receiving an offsetting lump-sum payment from CMS following 2018-2022 cuts later ruled unlawful are disproportionately rural, publicly owned, and nonacademic, according to a new study.
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Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
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Empowering Community Health Through Wellness and Faith
April 23rd 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In the third episode, Camille Clarke-Smith, EdD, MS, CHES, CPT, discusses approaching community health holistically through spiritual and community engagement.
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Kaiser Permanente was hit by a data breach in mid-April, impacting 13.4 million health plan members; GlaxoSmithKline (GSK) sued Pfizer and BioNTech for allegedly infringing on its messenger RNA technology patents in the companies’ COVID-19 vaccines; the CDC announced the first-known HIV cases transmitted via cosmetic injections.
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