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| Hello Friends
Having spent a few decades dealing with Medicare and Medicaid from the perspective of pharmacy, I now found myself getting an education on managing a loved-one recently admitted to a nursing home. My mother-in-law (aged 98), spent the last four years as a self-pay home care patient. Her money ran out and has now been admitted to a nursing facility as a Medicare/Medicaid dual eligible.
I am getting schooled on the ins and outs of navigating her care. I am happy to report that she is being very well cared for. Her healthcare, personal care, and therapies are all running smoothly, and the facility staff have been great.
There have been a few bumps along the way, and I will fill you in on those as time passes. So far, I've discovered that it's the smaller things that are most troublesome, such as roommate compatibility, and require patience and persistence.
I'm learning.
Paul |
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| | | | Ways and Means Approves Pharmacy Bill
The House Ways and Means Committee voted to forward HR 3164 to the full House. This legislation authorizes Medicare to pay pharmacists for testing and treatment of several respiratory diseases. More
Medicare Trustee's Report Shows Trouble Earlier
The annual report of the Medicare Trustees on the status of the Medicare Trust Fund has been released. The news is not encouraging. The Trustees note that the trust fund is on an 'unsustainable fiscal path', and the Part A trust fund will be depleted in 2033 unless action is taken. More
Medicare GLP-1 Program Starts in July
Beginning July 1, Medicare will approve GLP-1 medications for obesity for Medicare beneficiaries. The plan is to charge a monthly fee of $50 and require initial prior authorization. Continue
US House Likely to Fast Track Prior Authorization Bill
The ' Improving Seniors' Access to Primary Care Act' (HR 3514), which has 290 co-sponsors, would streamline prior authorization requirements in Medicare Advantage plans. The overwhelming number of supporters make the bill a candidate to be fast-tracked in the House by placing it on the 'consensus calendar'.
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CMS Issues Proposed Rule to Codify Drug Price Negotiations
Citing the Medicare price negotiation statute requirement to create permanent rules for the Medicare drug pricing negotiations, CMS has proposed to close some loopholes pharma companies have used to exclude certain drugs from price negotiation and other issues. More
CMS Press Release
CMS Announces Changes in Medicaid Demonstration Projects
One-third of Medicaid spending is disbursed through demonstration projects. CMS has announced it will enforce the requirement that demonstration projects will not be approved or renewed unless the Chief Actuary confirms that the project will not increase Medicaid spending for programs the demonstration project is intended to replace. CMS Press Release
KFF: The State of Medicare Advantage in 2026
Managed Medicare eclipsed traditional Medicare in 2023 and is now the most common form of care delivered under Medicare. While Medicare Advantage is popular, it is also more expensive than traditional Medicare. More
Inspector General Reports on Unimplemented Recommendations
The HHS Inspector General (OIG) reports that last year the office issued 35 recommendations to the HHS and a year later, only 4 of those recommendations have been implemented. Urgent, unresolved issues include those related to public health insurance programs, and Medicare and Medicaid program integrity. More |
| | | | TrumpRx Adds More Drugs
President Trump announced that his administration's direct-to-consumer platform has recently added 160 additional drugs, bringing the total available products on the site to more than 800. More
Fewer Drug shortages, but Shortages are lasting Longer
The total number of drugs in shortage has decreased from 2023 levels, but the drugs remaining in shortage now remain in shortage for more than five years. Injectable and infusion drugs are most affected, and pediatrics medicines are more likely to be on the shortage list. More
Forum Extended Care Pharmacy Named Best Place to Work
For the sixth consecutive year, LTC Pharmacy Forum Extended Care Services has been recognized as one of the best places to work in Illinois. Forum Extended Care President Brian Kramer attributes the company's workplace to the quality of the people who work there. More
Docs: Don't Call Us 'Providers'
In an unusual display of arrogance (even for physicians) the American Medical Association House of Delegates voted to resist using the term 'provider' in describing those anointed with a medical degree. more |
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