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| Happy New Year!
Each year I try to estimate how long into the year people will continue to wish me the best of the new year. I have noticed that the novelty greeting tends to begin hibernation around the third week of January, while 20 years ago it was not unusual to hear the salutation late into February. Perhaps our attention spans actually are getting shorter.
With the new year comes the flurry of predictions. Almost each one is wrong, but we keep asking, and those who answer sleep secure in the knowledge that no one will remember they failed to predict we would be seriously discussing annexing Greenland.
The New Year should be a time of optimism and good will. I resolve to remain cheerful, as well as amazed at what emerges from inside the beltway and our state capitals. Resist cynicism and stay in touch.
Paul |
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| | | | LTC Pharmacy Bill Adds Sponsors, Passage Possible?
HB 5031, the 'Preserving Patient Access to Long-Term Care Pharmacies Act', now has 33 sponsors, and the Senate companion, S 3159, has 2, both senators from Oklahoma. While passage is possible, there are headwinds:
There has been no official cost estimate, and the CBO suggests the ACA subsidy restoration (see below) may cost as much as $350 billion over 10 year, adding more expenditures on top of that may doom prospects for fiscal hawks. However, frail seniors are a sympathetic group, and if Congress decides that this issue might help them in this year's election cycle, anything could happen.
US House Appears Ready to Extend ACA Subsidies
The rarely used 'discharge petition' has forced House Speaker Johnson to allow a vote on the 'Bipartisan Health Insurance Affordability Act', which will reinstate the expired Affordable Care Act subsidies for participants with incomes up to 700 percent of the poverty level. The legislation also include requirements for PBMs that ban spread pricing, requires passing along all rebates, and limits PBM compensation to 'bona fide service fees'. More
President may veto ACA subsidy extension: President Trump suggested he may veto any attempt to extend ACA premium subsidies, which recently passed the House of Representatives. More
CMS Announces 'Balance' Payment Model to Cover GLP-1 Drugs
The objective is to provide access to weight loss drugs to people enrolled in Medicare and Medicaid, CMS announced, as it unveiled the voluntary "Balance" payment model. The approach requires manufacturers to enter into an agreement with CMS to guarantee net pricing, standardized coverage criteria, and the provision of evidence-based lifestyle support.
CMS Announcement
HealthcareFinanceNews.com
FDA Approved 46 Novel Drugs in 2025
Despite the intragency chaos within the nation's top drug regulator, the FDA finished the year having approved 46 new medicines. Not too bad, given all the distractions. See the List
FDA Approves Oral GLP-1 Drug
The FDA announced the approval of the first oral GLP-1 drug. In this case, it is Novo-Nordisk's Wegovy. The company plans to offer the drug directly to patients for $149 per month for cash-paying customers. More
President Trump Announces 'Great' Healthcare Plan
The Whitehouse announced the President's new healthcare plan. The announcement didn't include any details, except that money would be going to consumers, not to health insurers or providers.
Whitehouse |
| | | | Health Spending Tops $5 Trillion in 2024
The CMS Office of the Actuary reports that healthcare spending in the US reached $5.3 trillion, a 7.2% increase over 2023. This marks the return of healthcare spending to 18 % of GDP, a mark it hadn't achieved since 2021. The increase in total cost appears to be related to heavier volumes of services rather than price increases.
Health Affairs
Medpage Today
Health Insurers Early Refills Cost Medicare $3 Billion per Year.
A study conducted by the Wall Street Journal reveals that mail order pharmacy practices of dispensing early refills cost Medicare and its beneficiaries some $billion per year. Insurers United Healthcare and Humana defended their practices.
More
Homeless Shelters for Seniors?
KFF reports on efforts to come to the aid of the increasing number of seniors who have become homeless. Conventional shelters are often unable to accommodate people with chronic medical conditions, especially seniors who find it impossible to manage or obtain necessary medications. Inventive solutions have been developed to respond to the need.
OpenAI Launches ChatGPT Health
AI giant OpenAI announced the release of ChatGPT Health, a feature that connects a user's health records and health apps with ChatGPT to provide more personalized responses to health-related prompts. More
Anthropic Announces Claude for Healthcare
Not to be outdone by OpenAI (see above), AI pioneer Anthropic announced that it has released its own healthcare platform, Claude for Healthcare, which will be HIPAA-compliant, and will help with prior authorization, patient care coordination, and able to help with regulatory submissions. More
NYC Nurses Go On Strike
About 15,000 New York City nurses are striking at five hospitals, making this the largest nursing strike in the history of the city. Both sides maintain that justice is on their side. More
Nursing Home Capacity Declines
Since the COVID-19 pandemic, nursing home capacity has declined. Researchers estimate that 25 percent of nursing homes experienced 15 percent or more reductions in capacity. More
Federal Judge Approves Settlement in Pharmerica Data Breech
A federal judge gave preliminary approval to settlement terms against LTC Pharmacy Pharmerica of $5.3 million, related to a data breech that exposed some customer and employee data in 2023. More |
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