https://www.goodhousekeeping.com/health/a38833764/heart-health-facts/
Monday, January 31, 2022
As Medicaid Enrollment Soars, States Ask MCOs to Intensify Social Determinants of Health Efforts
States are moving to better
address social determinants of health (SDOH) and improve health equity in their
Medicaid programs, and they’re asking MCOs to drive the change, according to an
analysis of recent requests for proposals (RFPs) from advocacy group Together
for Better Medicaid. The report identified RFPs from 10 states that have
extensive SDOH and equity-based requirements for MCOs, from member screenings
and staff training to close collaboration with community-based organizations
(CBOs). Meanwhile, Medicaid enrollment has surged in all 10 states amid the
COVID-19 pandemic. National Medicaid enrollment climbed 18.4% from March 2020
to December 2021, according to AIS’s Directory of Health Plans. See an overview
of the most common SDOH requirements and the 10 states’ recent enrollment
patterns below.
SOURCE: DHP, AIS’s Directory of Health Plans; “Medicaid Managed Care: Strategies
to Address Social Determinants of Health and Health Equity,” prepared for
Together for Better Medicaid by Health Management Associates (HMA), December
2021.
Georgia is suing the Biden administration after HHS revoked...,
...a work requirement from the state’s partial Medicaid expansion, according to a Jan. 21 press release. The original waiver, approved by the Trump administration in October 2020, allowed uninsured adults living at or below the federal poverty line to become eligible for Medicaid benefits if they participated in 80 or more hours per month of work, volunteering, school or another qualifying activity. Georgia currently serves 2,612,001 Medicaid beneficiaries, with 75.7% enrolled in managed care plans.
From AIS’s Directory of Health PlansWhat Can Hepatitis B Drugs Tell Us About Generic Pricing Games?
by Leslie Small
While the average price that pharmacies pay for a common
hepatitis B treatment has seen a steep drop as more generics entered the
market, the list price for the drug — which helps determine patient cost
sharing — has stayed stubbornly high, according to new research published in JAMA. The study’s authors say
their findings “highlight the need for policies that improve transparency
around generic drug financing and pharmaceutical benefit manager practices,”
but one industry expert points out that there are also private-sector solutions
to the problem arising.
Affordability problems prompt study
- According to study author Jonathan Alpern, M.D., an
infectious diseases specialist with HealthPartners in Saint Paul, Minn.,
the impetus for examining the market forces surrounding the generic,
entecavir, was simply that “patients were having trouble affording the
medication.”
- Alpern and his colleagues found that as the number of
entecavir manufacturers increased from one to 11 between 2014 and 2018,
the National Average Drug Acquisition Cost (NADAC) for the antiviral drug
plummeted from $30.12 to $1.93 per 0.5-mg tablet. But the average
wholesale price (AWP) remained constant at $44.43 during that
time.
- That artificially high AWP can have real consequences
for patients, the findings of Alpern’s study suggest. For members of
commercial health plans, average out-of-pocket spending per 30-day supply
of generic entecavir rose from $41 in 2014 to $52 in 2018. For Baraclude,
the brand-name version of entecavir, out-of-pocket spending per 30-day
supply increased from $118 in 2014 to $165 in 2018.
Consumers have other options
- Elan Rubinstein, Pharm.D., principal of EB Rubinstein
Associates, tells AIS the results of Alpern’s study reveal a stubborn
problem with how drugs are priced. “Generic competition did bring down the
net cost of entecavir, even while the list price remained high,” he says.
“High list — even 90% higher than net — is standard generic drug industry
practice.”
- However, “the high out of pocket costs for entecavir and
other generics is something that, given GoodRx and companies like
it…patients can do something about themselves directly, bypassing their
PBM and pharmacy benefits altogether,” according to Rubinstein.
- However, “the awful part is that patients would need to
do an end-run of their own pharmacy plan, rather than depend on their
pharmacy plan to provide them with a fair price for their generic
prescription,” he adds. “In my view, this is a scandal that the PBMs and
retail pharmacies co-own, should be ashamed of and should be held to
account for.”
Subscribers may read the in-depth article online. Learn more about subscribing to AIS Health's publications.
Cases spike at Fort Worth prison; whistleblower complaint says top staff have no COVID plan
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Cases spike at Fort Worth prison;
whistleblower complaint says top staff have no COVID plan |
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“It’s been pure chaos,” Holli Wrice, who is incarcerated at
the women’s prison, said. “Carswell is still without a plan.” |
The Vaccination Campaign
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