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How PBM execs want to reform the Rx pricing system

April 10, 2019


Executives from five of the nation's largest pharmacy benefit managers (PBMs) during a Senate Finance Committee hearing on Tuesday said they would support legislation to reform PBMs' current drug pricing system by increasing transparency and prohibiting PBMs from charging Medicare and Medicaid higher rates for prescription drugs than pharmacies.

How CMS wants to ease Medicare Part D plans' transition to proposed rebate rules

April 9, 2019


If CMS moves forward with proposed changes to eliminate certain prescription drug rebates in Medicare and Medicaid plans, the agency will launch a two-year demonstration program to ease Medicare Part D plans' transition.

Inside Nebraska's plan to implement its voter-approved Medicaid expansion—with work requirements

April 3, 2019


Nebraska officials on Monday unveiled a plan to launch the state's voter-approved Medicaid expansion and request the federal government's permission to implement a tiered approach to Medicaid work requirements.

Why 2 Republican AGs just urged an appeals court to save the ACA

April 3, 2019


Two Republican state attorneys general are calling on a federal appeals court to uphold the Affordable Care Act, as President Trump and GOP congressional leaders work to establish their plan of action if the case challenging the law ultimately reaches the Supreme Court, and the law is struck down.

CMS approves first-ever partial Medicaid expansion

April 1, 2019


CMS on Friday approved Utah's request to implement a partial Medicaid expansion, just days after Georgia Gov. Brian Kemp (R) signed into law a bill that authorizes his administration to seek federal permission to reform the state's health care system, including seeking a partial Medicaid expansion.

Most children's hospitals can avoid the value-based care revolution. So why is this hospital taking the plunge?

April 1, 2019


Although value-based care models are optional for children's hospitals, Dayton Children's Hospital is choosing to take on value-based financial risk.

Centene to purchase WellCare in $15.3B deal, forming a Medicare, Medicaid 'powerhouse'

March 29, 2019


Centene this week announced that it will buy WellCare Health Plans for $15.3 billion—a move that will increase Centene's Medicare Advantage business and further solidify the insurer as the biggest insurer of Medicaid managed care plans.

A judge just struck down Medicaid work requirements in Arkansas, Kentucky. Here's what that means.

March 28, 2019


A federal judge on Wednesday struck down Medicaid work requirements in Arkansas and Kentucky—a decision that some legal experts say could eventually wind up before the Supreme Court.

CMS proposes significant changes to TAVR program requirements. Here's what you should know.

March 28, 2019


CMS on Tuesday proposed a set of policies that would make it easier for providers to meet surgical volume requirements to launch a transcatheter aortic valve replacement program and receive Medicare and Medicaid reimbursement for the procedure.

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