It has been fun to see the year really start to kick off this week with a bunch of policy releases.
Shortages. Generic shortages are caused by a myriad of factors, but a big piece is the race to the bottom for prices. A fraction of a penny less and a contract shifts to another manufacturer. The work being done by Senate Finance is poking at the right questions and one of the answers – getting Medicare to pay more for shortage prevention. Good primer if you’re getting into this area and the answers must be driven (at least partially) by the government so this is just a nice start.
The Health Policy In/Out List for 2024. The Peterson-KFF Health System Tracker released a list of health cost and affordability issues they are following for 2024. It’s good. A head nod if you know the area well, a cheat sheet of what you should know if the topic isn’t your thing.
Nothing but Net. This week in the New England Journal of Medicine had the results of an analysis that looked at the differential between 340B claims and hospital reimbursement for drug infusions. The results? 340B eligible hospitals retained 64.3% of insurer drug expenditures compared 44.8% for non-340B hospitals. Let’s move beyond the 340B angle, what about the reimbursement by private insurers overall? It does make you question the ability of the Inflation Reduction Act to reign in commercial prices.
States on the move. Over the past few years, states have really ramped up their drug pricing law efforts. Every day I know I’m using phrases like upper payment limits, prior authorization, importation, PDABs (prescription drug affordability boards). And while I follow it at the bigger player level (CO, FL, MD, OR, etc.), there are questions about what is happening in other states as well. NASHP has an updated tracker if you want to dig into what’s happening on the issues by state.
Bookmark for later. You might not need it this week but, at some point you might, Wakely did a nice piece on Medicare Advantage organization revenue projection. Pair this with the MedPAC’s payment basics and you’ve got a good overview to dig into.
Labor of love. A working group at the Aspen Institute released a set of recommendations for home-based healthcare and services available to Medicare beneficiaries and their unpaid family caregivers. There are an estimated 42 million caregivers providing home care for someone 50 and over; an economic value of $600 billion per year. The report provides recommendations for study/consideration but the caregiver section was of interest. It recommends looking at ways to pay caregivers who leave the workforce to provide caregiving services. Certainly, bigger than Medicare but an interesting push that could help home health services grow.