Pharmacy benefit managers have curtailed in-person audits of pharmacy claims during the pandemic, switching to virtual audits done by computer. That has markedly increased the number of claims they can review — and the chances for payment denials — squeezing pharmacies and bringing in more cash for the benefit companies.
The Medicare rule, designed by the Trump administration to take money away from drug industry brokers and provide refunds to patients, has not been implemented. But budget analysts say if it were, it would cost the government money. So senators are pushing the rule aside and claiming to save billions of dollars, which they want to use instead on new projects.
The makers of Aduhelm, a drug approved last month despite concerns raised by experts about its effectiveness, have launched a website and ads designed to urge people who are worried about their memory to ask doctors about testing. But some health advocates say it is misleading because some memory loss with aging is normal.
Sen. Ron Wyden (D-Ore.), who is helping to negotiate the health care spending framework for the Democrats’ budget plan, said lawmakers may have to settle for very basic versions of programs deployed in the package. But the key, he added, is to get the “architecture of these changes, bold changes,” started and show people what is possible.
The July 9 directive addresses the importation of prescription drugs and broader efforts to reduce the high cost of medicines.
Democrats in Congress reached a tentative agreement to press ahead on a partisan bill that would dramatically expand health benefits for people on Medicare, those who buy their own insurance and individuals who have been shut out of coverage in states that didn’t expand Medicaid. Meanwhile, controversy continues to rage over whether vaccinated Americans will need a booster to protect against covid-19 variants, and who will pay for a new drug to treat Alzheimer’s disease. Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews KHN’s Rae Ellen Bichell, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a mother and daughter who fought an enormous emergency room bill.
In an interview for KHN’s “What the Health?” podcast, HHS Secretary Xavier Becerra says the administration is eager for Congress to make changes to Medicare that will provide more benefits and make more older adults eligible for the program. He also said a priority will be making permanent the enhanced premium subsidies for Affordable Care Act marketplace plans.
Health and Human Services Secretary Xavier Becerra is the special guest for this bonus episode of KHN’s “What the Health?” podcast. He and host Julie Rovner discuss a breadth of topics the secretary oversees, including covid-19, prescription drug prices, Medicare, Medicaid and the Affordable Care Act.
Aduhelm, approved by the Food and Drug Administration last month despite questions about its efficacy, could be prescribed to at least 1 million patients a year, for a price tag of about $56 billion. Experts suggest there might be better ways to spend that money.
As more independently owned community pharmacies close, a Colorado town is crowdsourcing ways of getting prescription medicines delivered to those who can’t travel the long distance to the closest pharmacy. But even those stopgap measures don’t always work.
