CMS’ Proposed 2.8% Physician Pay Decrease For CY2025 Earns Quick Condemnation From Docs

The Biden administration is proposing a 2.8% decrease to physician payments in its newly released pay proposal for physicians, drawing near-immediate protest from the industry. Unveiled Wednesday afternoon, the calendar year 2025 Medicare Physician Fee Schedule proposed rule outlines new policies focused on primary care, preserved telehealth flexibilities and a strengthened Medicare Shared Savings Program ...

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Lowering Prescription Costs For Medicare Beneficiaries Lifted Burdens For Nevadans, They Tell HHS Secretary

The Inflation Reduction Act calls for prescription drug prices for seniors on Medicare to be lowered and out-of-pocket expenses capped at $2,000 per year starting in 2025, the White House said. The act also capped the price of insulin, which helps regulate diabetes, at $35 a month for Medicare users.

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Pharmacy Middlemen Appear To Be Inflating Drug Prices, FTC Says

The Federal Trade Commission released a critical report detailing how pharmacy benefit managers—like CVS Health’s Caremark, Cigna’s Express Scripts and UnitedHealth’s Group OptumRx, which manage 80% of American prescriptions—could be driving up the costs of some medications and favoring their own pharmacies at the expense of independent drug stores.

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FTC Staff Objects To Big PBMs ‘Outsized Influence’ In Interim Report

The Federal Trade Commission staff is having trouble getting information from the big pharmacy benefit managers, but it believes that the big PBMs may have too "outsized influence" over the U.S. pharmaceutical system and may be steering prescription revenue to their own pharmacies.

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Wall Street Journal Roasts Medicare Advantage Plan Strategy

The Wall Street Journal has added to the pressure on Medicare Advantage plan issuers by publishing its own analysis of how the issuers score their enrollees’ health. The Medicare Advantage program gives private insurers a chance to use a combination of Medicare program money and some premium payments from enrollees to provide an alternative to traditional Medicare. The ...

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FTC Preparing Suit Against Drug Middlemen Over Insulin Rebates

The Federal Trade Commission is preparing a lawsuit against the three largest drug intermediaries over their use of rebates for insulin and other drugs, according to a person familiar with the probe. The agency has been investigating whether the rebate practices of insulin manufacturers and three pharmacy benefit managers — units of CVS Health Corp., ...

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Medicare Proposes 2.6% Bump To Hospital Outpatient Pay Next Year

The sweeping payment rule also solidifies continuous eligibility requirements for children in Medicaid and CHIP, and holds hospitals to higher obstetric care delivery standards.

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Keeping ACA Premium Tax Credits High May Cut 2025 Group Health Use

Congress will have to decide soon whether to continue a big, temporary increase in premium tax credit subsidies for Affordable Care Act public exchange plan coverage. If it lapses could increase enrollment in employer-sponsored coverage by millions.

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Health Care Industry Pushes Back Against Cybersecurity Proposal

A proposed rule that would require the nation's most critical industries to more quickly report cyberattacks is raising the ire of the health care industry, which claims the new directives could actually hinder its response in a crisis.

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Insurers Bilk Medicare for $50 Billion to Treat Fictitious Illnesses

Private insurance firms running Medicare Advantage programs have been overcharging the federal government billions of dollars by making patients look sicker than they really are, according to a report in The Wall Street Journal on Monday.

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