Sunday, July 3, 2022
    HomeHealthCalifornia senators advance 3 bills meant to crack down on health insurers

    California senators advance 3 bills meant to crack down on health insurers


    You’re studying the online version of D.C. Analysis, STAT’s twice-weekly publication in regards to the politics and coverage of well being and drugs. Join here to obtain it in your inbox.

    There could also be a backdoor approach to pay for Covid-19 uninsured care

    When HHS abruptly shut down its program to pay for Covid-19 take care of the uninsured, it left hospitals, pharmacists, clinics, and testing corporations in a lurch. HHS had been paying out greater than $1 billion a month.


    However not less than for some services, there should be a way to get some of those costs covered.

    Specialists say FEMA reimburses some bills for testing, vaccines, and coverings if there’s no different payer — although utilizing it might be a significant administrative headache. It’s not open to everybody, as solely nonprofit well being care suppliers qualify, and the paperwork for them can be far more rigorous than it was below the HHS packages. Learn extra in regards to the potentialities and pitfalls of the choice in my latest story, here.


    The Senate’s psychological well being invoice is sweet information for digital well being corporations

    A bipartisan group of senators this morning proposed axing a restriction on seniors’ entry to psychological well being companies through telehealth — a transfer that can be music to the ears of the digital-only telehealth corporations which have boomed throughout the pandemic.

    Congress determined to make Medicare protection for telemental well being companies everlasting again in 2020, however added a catch that seniors needed to have seen their supplier in individual inside the previous six months. The telehealth trade has aggressively lobbied to kill the supply earlier than it goes into impact, which is ready to occur as soon as HHS ends pandemic emergency guidelines. I’ve bought all of the details on the other provisions here.

    Hospitals preserve shopping for proton beams, even with shaky advantages and questionable profitability

    The arms race for prestigious medical facilities to construct their very own proton beams continues, even if it’s a dangerous funding that will drive up prices, my colleagues Bob Herman and Tara Bannow report in a new story this morning.

    One issue driving the proton remedy gold rush is a Medicare choice a few years in the past that enables the facilities to gather tens of hundreds of {dollars} for treating some sufferers that might obtain different, cheaper types of radiation that work simply as properly.

    And whereas some facilities are doing properly, there’s additionally a string of bond defaults and bankruptcies financed by obscure entities with checkered monitor data. Get the complete, unsparing image of the trade of their fascinating new deep dive.

    A foul week for insurers in California

    California senators superior not one, not two, however three payments this week meant to crack down on well being insurers, my colleague Nick Florko reviews.

    The payments would do the next:

    • Outlaw “white bagging,” a course of the place well being insurers associate with specialty pharmacies to ship a affected person’s infused medicine on to a hospital, reasonably than counting on a hospital’s personal in-house pharmacy. Insurers say the method helps them preserve drug prices down, however hospitals say it usually delays take care of critical situations like most cancers.
    • Require insurers to pay for medicine whereas a affected person is interesting a denial. Well being plans say the invoice would hamper their capability to handle drug costs, and hike insurance coverage premiums. Affected person advocacy teams say the invoice would make it possible for sufferers’ don’t have to attend for obligatory drugs.
    • Drastically enhance fines for insurers that violate the regulation. This invoice would enhance the bottom tremendous for quite a few violations – like denying sufferers protection for gender affirming care – from $2,500 to $25,000 per violation, per enrollee harmed.

    However it’s not over but: Not one of the payments has seen any motion but within the California Meeting.

    The drug pricing merry-go-round returns to PBMs

    This doesn’t occur usually: Two very highly effective bipartisan senators are out with an enormous new invoice that might push the FTC to maintain a more in-depth eye on pharmacy profit managers’ enterprise practices (a saga that my colleague Ed Silverman has covered extensively). And right here, their committee assignments matter: Sens. Maria Cantwell (D-Wash.) and Chuck Grassley (R-Iowa) are leaders on the 2 committees which have oversight of the FTC itself and antitrust points, which supplies this invoice an entire lot extra legs than your common two-pager. We’ll be watching — keep tuned.

    What we’re studying

    • As researchers scramble for solutions about rebound symptoms after Paxlovid treatment, Pfizer broadcasts it would promote its vaccines and medicines at not-for-profit costs to poor nations, STAT
    • Democrats refocus consideration on drug costs after Oregon major shakeup, Washington Post
    • Now that public well being measures to sluggish Covid-19 have been relaxed, different viruses and sicknesses are again with a vengeance, STAT
    • HHS Secretary Xavier Becerra formally established ARPA-H inside NIH, and named College of Maryland scientist Adam Russell because the performing deputy director, Bloomberg Law

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