January

ACA Rule Offers Plans Flexibility, but Also Reasons to Worry

January 28, 2019

When CMS released its proposed 2020 Notice of Benefit and Payment Parameters (NBPP) for the Affordable Care Act exchanges on Jan. 17, insurers likely breathed a sigh of relief, as impatience was mounting to see the annual omnibus regulation that helps them plan for the next benefit year.

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New Payment Models Emerge for Costly Pharma Therapies

January 28, 2019

As payers struggle to cover high-priced pharmaceutical therapies in a year in which the first drug costing more than $1 million is expected to launch in the U.S., new payment models are emerging — including a “Netflix”-like subscription model in Louisiana for hepatitis C virus treatment — that could offer ways for patients to be treated without bankrupting the health care system.

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Experts: Medicaid Block-Grant Waivers Would Be Bad for MCOs

January 28, 2019

The Trump administration is reportedly working on a way to let states use waivers to implement a block-grant system in their Medicaid programs — and if those plans come to fruition, Medicaid managed care organizations might not fare so well, some experts warn.

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With Work Requirements, More Than 18,000 People Lost Medicaid Coverage in Arkansas

January 28, 2019

by Jinghong Chen Arizona on Jan. 18 received CMS’s approval to implement Medicaid work requirements. In late December, the Trump administration approved work requirements for Medicaid programs in Maine and Michigan, though Maine Gov. Janet Mills (D) rejected the waiver in a letter sent to CMS on Jan. 22. To date, eight states have Medicaid […]

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News Briefs

January 28, 2019

UnitedHealth Group subsidiary Optum filed a federal lawsuit to protect its trade secrets from the health care venture being launched by Amazon, JPMorgan Chase & Co., and Berkshire Hathaway, Stat reported. Optum wants a court order to block former executive David Smith, who left last month to join the new venture, from sharing confidential corporate information he allegedly accessed before his departure.

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Louisiana’s ‘Netflix’ Model for HCV Is ‘Worth Watching Closely’

January 24, 2019

Since the introduction of Sovaldi (sofosbuvir) in September 2014 — at a cost of about $84,000 for the full 12-week course of treatment — other highly curative but expensive hepatitis C virus (HCV) treatments, known as direct-acting antiviral drugs, have proliferated in the U.S. market. Yet research released last June by the University of Pennsylvania School of Medicine, disputed as misleading by America’s Health Insurance Plans (AHIP), indicates that private insurers denied such coverage for 52.4% of patients, while Medicaid denied 34.5% and Medicare, 14.7%, between January 2016 and April 2017.

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