Court Blocks Trump Administration Restrictions on Birth Control

January 14, 2019

A federal court issued a nationwide injunction on Monday that prevents the Trump administration from interfering with women’s access to free birth control guaranteed under the Affordable Care Act.

The decision, by Judge Wendy Beetlestone of the Federal District Court in Philadelphia, extends a losing streak for President Trump, who has repeatedly been set back in his efforts to allow employers to deny insurance coverage of contraceptives to which the employers object on religious or moral grounds.

A federal court issued a nationwide injunction on Monday that prevents the Trump administration from interfering with women’s access to free birth control guaranteed under the Affordable Care Act.

The decision, by Judge Wendy Beetlestone of the Federal District Court in Philadelphia, extends a losing streak for President Trump, who has repeatedly been set back in his efforts to allow employers to deny insurance coverage of contraceptives to which the employers object on religious or moral grounds.

The rules were scheduled to take effect on Monday. The states of Pennsylvania and New Jersey challenged the rules before Judge Beetlestone, saying they would have to shoulder much of the burden of providing contraceptives to women who lost coverage under the Trump administration’s rules.

“The states’ harm is not merely speculative; it is actual and imminent,” Judge Beetlestone wrote. “The final rules estimate that at least 70,500 women will lose coverage….”

Read the full The New York Times article

House Dems announce sweeping investigation of drug pricing

January 14, 2019

House Democrats announced a sweeping investigation Monday of the pharmaceutical industry’s pricing practices, jockeying for the upper hand with the Trump administration on an issue that concerns Americans across the political spectrum.

Oversight and Reform Committee Chairman Elijah Cummings said he’s sent letters to 12 major drugmakers seeking detailed information and documents about pricing practices for brand-name drugs to treat diseases including cancer, diabetes, kidney failure and nerve pain.

House Democrats announced a sweeping investigation Monday of the pharmaceutical industry’s pricing practices, jockeying for the upper hand with the Trump administration on an issue that concerns Americans across the political spectrum.

Oversight and Reform Committee Chairman Elijah Cummings said he’s sent letters to 12 major drugmakers seeking detailed information and documents about pricing practices for brand-name drugs to treat diseases including cancer, diabetes, kidney failure and nerve pain.

Cummings, a Maryland Democrat, said he wants to find out why prices have increased so dramatically for some existing medications, as well as how drug companies determine the prices of newly introduced medicines. The committee also is seeking information on what the manufacturers do with revenue and what steps can be taken to reduce prescription drug costs….

Read the full The Associated Press article

Don’t Expect Major Action on Drug Prices in 2019, Experts Say

January 14, 2019

As 2019 gets under way, public outrage over high prescription drug prices does not appear to have abated, especially in light of recent news reports indicating manufacturers are raising prices on hundreds of drugs this month, AIS Health reported.

Yet there are plenty of reasons why this concern over drug prices might not result in any significant legislative or regulatory action, experts tell AIS Health. And whatever does occur might benefit health plans and PBMs more than challenge them.

By Leslie Small

As 2019 gets under way, public outrage over high prescription drug prices does not appear to have abated, especially in light of recent news reports indicating manufacturers are raising prices on hundreds of drugs this month.

Yet there are plenty of reasons why this concern over drug prices might not result in any significant legislative or regulatory action, experts tell AIS Health. And whatever does occur might benefit health plans and PBMs more than challenge them.

Walid Gellad at the University of Pittsburgh says there’s sure to be a lot of drug-pricing bills proposed — and even passed — by the House, but it’s not certain that any will become law. He says that’s because many Senate Republicans aren’t likely to be very interested in passing legislation that harms the pharmaceutical industry. “The real uncertainty is whether the president would get behind one of those bills, and if so, that could change things,” Gellad says.

One hot topic on Democrats’ legislative agenda will be allowing Medicare to negotiate drug prices with manufacturers. While the idea of broad-based Medicare price negotiation probably has little chance of passing, “there could be a tie-in between negotiation and external reference prices for Part D,” says Gerard Anderson, professor at Johns Hopkins University Bloomberg School of Public Health.

In fact, Sen. Bernie Sanders (I-Vt.) and other left-leaning lawmakers introduced a trio of drug-pricing bills on Jan. 10, one of which would direct HHS to negotiate lower prices for Part D drugs, and another that would peg the price of prescription drugs in the U.S. to the median price in five major countries.

Overall, Anderson says he expects most potential actions to lower drug prices will benefit the managed care sector, as the result could be lower costs for such companies.

On the regulatory front, Gellad says he expects “small changes here and there…[but] nothing that’s going to radically change prices now or over the next two years — or until the next election.” However, “the big one for me is whether there will be big action around rebates,” he adds.

If the prescription drug rebate structure changes fundamentally, “it’s going to create a challenge for PBMs and their underwriting strategies, because they have been driven by rebates over the last couple years,” says Brian Anderson, a principal with Milliman, Inc.

People on the Move

January 11, 2019

Aetna Takes On Largest-Ever Medicare Advantage Expansion for 2019

January 11, 2019

From 2017 to 2018, Aetna Inc. increased its Medicare Advantage membership by 18.9%, to 1.76 million lives. This trend will likely continue into 2019, as the insurer undertakes its largest-ever expansion into the market, adding 358 new counties. Aetna is currently ranked No. 3 in national MA market share, behind UnitedHealthcare and Humana Inc.

by Carina Belles

From 2017 to 2018, Aetna Inc. increased its Medicare Advantage membership by 18.9%, to 1.76 million lives. This trend will likely continue into 2019, as the insurer undertakes its largest-ever expansion into the market, adding 358 new counties. Aetna is currently ranked No. 3 in national MA market share, behind UnitedHealthcare and Humana Inc.

NOTE: Aetna did not experience membership gains between 15,000 and 20,000 lives in any state from 2017 to 2018.

SOURCE: DHP, AIS’s Directory of Health Plans