Policy & Regulation
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Wyden introduces price transparency bill targeting payers
The legislation stipulates that commercial insurers, as well as Medicare plans, provide an online tool and toll-free phone number for members to ask about cost of services and quality of providers.
By Shannon Muchmore • May 17, 2019 -
CMS pulls back on key Part D proposals
While the final rule is seen as a win for pharmas and insurers, pharmacists and drug stores were not pleased.
By Samantha Liss • May 17, 2019 -
Small PBMs urge Congress: Don't kill rebates
An HHS rule that would eliminate Medicare and Medicaid drug rebates could have the unintended effect of raising patients' drug costs, one executive said.
By Samantha Liss • May 16, 2019 -
CMS targets PBM spread pricing
The agency is concerned the practice of charging pharmacists and health plans different prices for the same drugs is inflating costs and increasing the burden on taxpayers.
By Samantha Liss • May 16, 2019 -
Federal lawmakers put forward competing proposals to ban surprise billing, with key difference
Both bills are bipartisan, but a draft bill in the House does not include arbitration, while the Senate plan does. The American Hospital Association supports such a provision, while the payer lobby group strictly opposes it.
By Shannon Muchmore • UPDATED: May 16, 2019 at 8:47 a.m. -
FTC commissioner: M&A outpacing agency funding
The regulator and other enforcers face multiple challenges in bringing enforcement actions against hospitals, FTC Commissioner Rebecca Kelly Slaughter said.
By Dana Elfin • May 15, 2019 -
In US-China tariff poker game, health supply chains stand to lose
Tariffs on medical equipment and supplies, plus duties on imported steel and aluminum, could result in millions of increased costs for the healthcare industry and U.S. patients.
By Barry Hochfelder • May 15, 2019 -
HITAC recommends leveraging demographic data to help patient matching
The move should help correctly match patients to their healthcare records, a key problem area highlighted by interoperability experts when HHS announced its rules on the topic in February.
By Rebecca Pifer • May 14, 2019 -
Cancer patients face sticker shock under short-term plans, study finds
Short-term insurance plans are facing scrutiny from Congress and patient advocates, who argue consumers are often unaware the plans offer only bare-bones coverage.
By Dana Elfin • May 14, 2019 -
As Trump wades in, states move on surprise billing
The political climate in Washington, where even historically bipartisan efforts move slowly at best, has left states to step in and do what they can.
By Shannon Muchmore • May 14, 2019 -
FDA finalizes interchangeable biosimilar advice, with insulin focus
The agency will generally require switching studies for biologic copycats seeking a valuable interchangeable license.
By Andrew Dunn • May 14, 2019 -
Uninsurance of children, parents inched back up in 2017, report finds
Both children and parents were more likely to be uninsured in states without Medicaid expansion, according to new research from the Urban Institute.
By Meg Bryant • May 13, 2019 -
Maryland's all-payer model shows limited effects for rural hospitals
The facilities had a 9% drop in outpatient visits but no change in inpatient utilization, readmission rate or emergency department visits, according to a new study in Health Services Research.
By Shannon Muchmore • May 13, 2019 -
Insured rate dips again, to 9.4% in 2018
About 1.1 million Americans lost insurance coverage in 2018, according to CDC's annual survey. That puts the total number of uninsured in the U.S. at 30.4 million.
By Tony Abraham • May 10, 2019 -
Trump prods Congress on surprise billing ban
The president called unexpected high-cost medical bills "one of the biggest concerns Americans have about healthcare."
By Shannon Muchmore • May 09, 2019 -
FTC judge upholds unraveling of microprocessor prosthetic knee firms deal
Ottobock must sell off its recent acquisition of microprocessor prosthetic knee maker Freedom Innovations over market concentration concerns.
By Dana Elfin • UPDATED: May 8, 2019 at 2 p.m. -
340B drug program payment cut struck down again
A district court judge remanded the rate adjustment rules back to HHS but did not order hospitals be compensated for lost 340B payments.
By Shannon Muchmore • May 08, 2019 -
Drugmakers will soon be required to disclose prices in TV ads
Forcing pharma's hand, the Trump administration finalized a proposal requiring list prices in direct-to-consumer advertising, a move that could result in a legal challenge from industry.
By Ned Pagliarulo • May 08, 2019 -
Payers had best individual market performance in 2018 since ACA began
A Kaiser Family Foundation analysis on the profitability of the ACA individual market also found insurers expect to pay a record amount of rebates to consumers for not meeting the medical loss ratio threshold in 2018.
By Rebecca Pifer • May 08, 2019 -
Kaiser Permanente rolls out EHR-integrated program to tackle social determinants of health
The social health network, a partnership with Unite Us, will be available within three years to all 12.3 million Kaiser Permanente members and the communities it serves, the health system said.
By Meg Bryant • May 07, 2019 -
CMS interstate insurance idea rebuffed by payers, state regulators
Commenters advised the agency against further policymaking on the issue, arguing it could invite a "race to the bottom" that only stands to benefit insurers.
By Tony Abraham • May 07, 2019 -
HHS officials defend interoperability rules to Senate critics
"To the extent this is delayed or prevented, the American public is not in control of their healthcare," the Office of the National Coordinator for Health IT head Don Rucker warned.
By Rebecca Pifer • May 07, 2019 -
Seniors switching to MA already have lower costs than traditional Medicare beneficiaries
A new Kaiser Family Foundation study raises questions about whether MA payment rates, which are based on spending for similar people in traditional Medicare, are too high.
By Rebecca Pifer • May 07, 2019 -
CMS draft guidance clarifies hospital co-location policy
The American Hospital Association has repeatedly urged the agency to make its policy clear, noting some hospitals were dismantling co-location and shared service arrangements out of concern they would be found noncompliant.
By Meg Bryant • May 06, 2019 -
Medicare drug rebate ban not magic balm, federal budget forecasters say
The Trump administration plan to eliminate certain drug rebates in Medicare would increase federal spending by $177 billion over a decade, the CBO found.
By Jonathan Gardner • May 03, 2019
