Morning Briefing
Summaries of health policy coverage from major news organizations
In Face Of Huge Costs, Medicare May Limit Eligibility For Alzheimer's Drug
The recent approval of a high-price Alzheimer鈥檚 drug raises the prospect that the federal Medicare system could threaten to sharply curtail which patients will qualify for a medicine that has limited clinical benefit but is likely to cost billions of dollars in coming years. Biogen Inc. priced the drug Aduhelm at $56,000 a year. Wall Street analysts estimate it could eventually surpass $5 billion in yearly sales, mostly paid by Medicare, while some health economists warn the bill would be multiples higher. (Walker and Burton, 6/28)
Medicare spending on Aduhelm isn鈥檛 just an abstract number. Precisely how big spending ends up being will have financial consequences for all taxpayers, and for all Medicare patients who could see higher monthly premium payments. ... The interactive below shows exactly how big that impact could be, depending on how many people take it, compared to the Medicare program鈥檚 current spending on every single drug administered by doctors, across the entire country. (Cohrs and Parker, 6/28)
CMS on Monday proposed expanding its home health value-based purchasing program nationwide. The CMS Innovation Center first tested the model in January 2016. The program shifts paying for Medicare home health services based on volume to a system that pays for value and quality. Currently, all Medicare-certified home health agencies in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington participate in the program. (Christ, 6/28)
Prescription drugs with some of the highest Medicare spending also had the highest level of direct-to-consumer advertising, a recently-released GAO report found. The GAO found the Medicare program and its beneficiaries spent nearly $324 billion on prescription drugs advertised to beneficiaries and other consumers between 2016 and 2018. (Reed, 6/28)
More than 90% of Americans are unaware of a CMS rule allowing patients to view and compare treatment costs on hospital websites so they can shop for lower priced care, according to a recent Kaiser Family Foundation survey. While only 9% of seniors have researched treatment prices online, they are more likely to know about the rule change than any other age group. Households with incomes over $90,000 are also more likely to know about hospitals' requirement to disclose pricing data. But these wealthier households spent less time researching prices than those with incomes under $40,000. (Gellman, 6/28)
In聽 news from state Medicaid programs 鈥
Some Democrats are eager to build on their Affordable Care Act victories in the Supreme Court by filling a gaping hole created along the way: the lack of Medicaid coverage for millions of low-income Americans in 12 states. But so far, Republican leaders in those states are refusing to use the health law to expand Medicaid, despite considerable financial incentives offered under the law and sweetened under the Biden administration. Some are trying to defy the will of their own voters, who passed ballot initiatives calling for expansion. (Kliff, 6/28)
Changes to North Carolina Medicaid patients go into effect July 1. Some people may now be re-assigned to new providers without knowing so. The state is shifting more than a million people are shifting to the a Medicaid managed care program. 鈥淚鈥檓 not lying to you when I say I鈥檓 really scared about the health of the patient,鈥 said Bart Fiser, Vice President of Corporate Revenue Cycle and Managed Care at Cape Fear Valley Health. (Retana, 6/28)
Louisiana has restarted its bid process for multibillion dollar Medicaid contracts managing the health care of nearly 1.6 million people, trying to end its patchwork of emergency contracts after a legal dispute scuttled the last attempt at new deals. (6/28)
Harris, alongside others at the Tennessee Coalition for Better Aging, are recommending the state allocate $157 million from its federal Medicaid funding, to advance home-based and community-based state services for Tennesseans who need these services. The money would come from the American Rescue Plan Act, a federal COVID-19 relief package with money awarded to each state.聽The coalition called on Gov. Bill Lee and TennCare聽to file an action plan through Medicaid for funding before the July 12 deadline.聽 (Martin, 6/28)
Virginia is expanding its Medicaid program to provide a comprehensive dental benefit to poor adults, meaning more than 750,000 Virginians will be eligible for the benefit starting Thursday. (6/28)
Gender-affirming health care will soon become a covered benefit for Alaskans on Medicaid. The change is the result of a settlement in聽a lawsuit聽filed against the state health department that challenged the legality of excluding transgender Alaskans from health coverage related to their gender transitions. Last year, three Alaskans sued the Alaska Department of Health and Social Services Commissioner Adam Crum and the department, arguing the state鈥檚 refusal to cover transition-related health care was a civil rights violation. (Berman, 6/28)
Oregon鈥檚 State Senate on Saturday passed a bill that would make illegal immigrants in the state eligible for Medicaid-funded medical services -- sending the legislation to Democratic Gov. Kate Brown for signature. The bill, HB 335, expands eligibility to adults who would otherwise qualify for Medicaid-funded state medical assistance program but are excluded due to their immigration status. It passed 17-11 in the Senate, after having passed the House 37-21 earlier this week. (Shaw, 6/27)
