In Face Of Huge Costs, Medicare May Limit Eligibility For Alzheimer’s Drug

In Face Of Huge Costs, Medicare May Limit Eligibility For Alzheimer’s Drug

And Stat offers an interactive that guesses at the financial hit Medicare may take from Aduhelm $56,000-a-year price tag. In other Medicare news, the Centers for Medicare and Medicaid Services move to expand its home health value-based purchasing program nationwide.

The Wall Street Journal:
Costly New Alzheimer’s Drug Could Force Medicare To Restrict Access 

The recent approval of a high-price Alzheimer’s drug raises the prospect that the federal Medicare system could threaten to sharply curtail which patients will qualify for a medicine that has limited clinical benefit but is likely to cost billions of dollars in coming years. Biogen Inc. priced the drug Aduhelm at $56,000 a year. Wall Street analysts estimate it could eventually surpass $5 billion in yearly sales, mostly paid by Medicare, while some health economists warn the bill would be multiples higher. (Walker and Burton, 6/28)

Will Biogen’s New Alzheimer’s Drug’s Burden On Medicare Be Big, Huge, Or Catastrophic?

Medicare spending on Aduhelm isn’t just an abstract number. Precisely how big spending ends up being will have financial consequences for all taxpayers, and for all Medicare patients who could see higher monthly premium payments. … The interactive below shows exactly how big that impact could be, depending on how many people take it, compared to the Medicare program’s current spending on every single drug administered by doctors, across the entire country. (Cohrs and Parker, 6/28)

Modern Healthcare:
CMS Eyes Expanding Home Health Value-Based Pilot Nationwide

CMS on Monday proposed expanding its home health value-based purchasing program nationwide. The CMS Innovation Center first tested the model in January 2016. The program shifts paying for Medicare home health services based on volume to a system that pays for value and quality. Currently, all Medicare-certified home health agencies in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington participate in the program. (Christ, 6/28)

Medicare Beneficiaries Spent More On Advertised Drugs, Study Finds 

Prescription drugs with some of the highest Medicare spending also had the highest level of direct-to-consumer advertising, a recently-released GAO report found. The GAO found the Medicare program and its beneficiaries spent nearly $324 billion on prescription drugs advertised to beneficiaries and other consumers between 2016 and 2018. (Reed, 6/28)

Modern Healthcare:
Most Americans Unaware Of CMS Price Transparency Rule

More than 90% of Americans are unaware of a CMS rule allowing patients to view and compare treatment costs on hospital websites so they can shop for lower priced care, according to a recent Kaiser Family Foundation survey. While only 9% of seniors have researched treatment prices online, they are more likely to know about the rule change than any other age group. Households with incomes over $90,000 are also more likely to know about hospitals’ requirement to disclose pricing data. But these wealthier households spent less time researching prices than those with incomes under $40,000. (Gellman, 6/28)

In  news from state Medicaid programs —

The New York Times:
Democrats Are Divided Over How To Expand Medicaid In 12 States.

Some Democrats are eager to build on their Affordable Care Act victories in the Supreme Court by filling a gaping hole created along the way: the lack of Medicaid coverage for millions of low-income Americans in 12 states. But so far, Republican leaders in those states are refusing to use the health law to expand Medicaid, despite considerable financial incentives offered under the law and sweetened under the Biden administration. Some are trying to defy the will of their own voters, who passed ballot initiatives calling for expansion. (Kliff, 6/28)

CBS 17:
More Than A Million Medicaid Patients Moved To New Plan, Many Unaware 

Changes to North Carolina Medicaid patients go into effect July 1. Some people may now be re-assigned to new providers without knowing so. The state is shifting more than a million people are shifting to the a Medicaid managed care program. “I’m not lying to you when I say I’m really scared about the health of the patient,” said Bart Fiser, Vice President of Corporate Revenue Cycle and Managed Care at Cape Fear Valley Health. (Retana, 6/28)

Louisiana Kicks Off New Search For Medicaid Contractors

Louisiana has restarted its bid process for multibillion dollar Medicaid contracts managing the health care of nearly 1.6 million people, trying to end its patchwork of emergency contracts after a legal dispute scuttled the last attempt at new deals. (6/28)

The Tennessean:
Advocates For Elderly Ask Tennessee To Help Caregivers With Federal Funds

Harris, alongside others at the Tennessee Coalition for Better Aging, are recommending the state allocate $157 million from its federal Medicaid funding, to advance home-based and community-based state services for Tennesseans who need these services. The money would come from the American Rescue Plan Act, a federal COVID-19 relief package with money awarded to each state. The coalition called on Gov. Bill Lee and TennCare to file an action plan through Medicaid for funding before the July 12 deadline.  (Martin, 6/28)

Anchorage Daily News:
Alaska Medicaid To Begin Covering Gender-Affirming Health Care After Class-Action Lawsuit

Gender-affirming health care will soon become a covered benefit for Alaskans on Medicaid. The change is the result of a settlement in a lawsuit filed against the state health department that challenged the legality of excluding transgender Alaskans from health coverage related to their gender transitions. Last year, three Alaskans sued the Alaska Department of Health and Social Services Commissioner Adam Crum and the department, arguing the state’s refusal to cover transition-related health care was a civil rights violation. (Berman, 6/28)

Fox News:
Oregon Lawmakers Pass Bill To Make Illegal Immigrants Eligible For Medicaid, Dem Gov Expected To Sign Into Law

Oregon’s State Senate on Saturday passed a bill that would make illegal immigrants in the state eligible for Medicaid-funded medical services — sending the legislation to Democratic Gov. Kate Brown for signature. The bill, HB 335, expands eligibility to adults who would otherwise qualify for Medicaid-funded state medical assistance program but are excluded due to their immigration status. It passed 17-11 in the Senate, after having passed the House 37-21 earlier this week. (Shaw, 6/27)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

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