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Medicare's surprising slowdown: Why per-person costs are falling—and what the health system can learn from it

September 18, 2018


When actuaries detected a slowdown in Medicare spending growth a few years ago, Medicare officials claimed it was a one-time blip due to the recession. But one expert is spearheading research that paints a different picture—revealing a sustained slowdown in spending that the larger health care system could learn from.

DOJ OKs proposed Cigna-Express Scripts merger

September 18, 2018


Makan Delrahim, assistant attorney general of the Department of Justice's antitrust division, says, "After a thorough review of the proposed transaction, the antitrust division has determined that the combination of Cigna … and [Express Scripts] … is unlikely to result in harm to competition or consumers."

House committee advances bill targeting pharmacy 'gag' clauses

September 17, 2018


The bill, called the Know the Cost Act, now heads to the House floor for a vote, though it is not yet clear when any vote will be scheduled.

1 in 4 people with diabetes have rationed insulin. Here's why that's dangerous.

September 14, 2018


About one in four diabetics has resorted to rationing their insulin doses to combat rising prices—but the practice can have lethal consequences.

CMS makes it easier for US residents to avoid the 2018 individual mandate penalty

September 13, 2018


CMS in new guidance is making it easier for U.S. residents to qualify for an exemption from the Affordable Care Act's (ACA) individual mandate tax penalty by allowing consumers who could not afford coverage to claim the exemption on their federal taxes, without supporting documentation.

400% Rx price increase was 'moral requirement,' pharma CEO insists

September 13, 2018


In response to questions about a recent 400% price increase for the antibiotic nitrofurantoin, Nostrum Laboratories CEO Nirmal Mulye says, "I think it is a moral requirement to make money when you can … to sell the product for the highest price," adding that he is in the pharmaceutical "business to make money."

As ED prices rise, more patients are seeking care at retail clinics

September 12, 2018


Researchers say ED visits for low-acuity conditions declined by 36% from 89 visits per 1,000 members in 2008 to 57 visits per 1,000 members in 2015, while non-ED visits for low-acuity conditions increased by 140% from 54 visits per 1,000 members in 2008 to 131 visits per 1,000 members in 2015.

Hospitals sue HHS to end delay of 340B overcharge rule

September 12, 2018


American Hospital Association President and CEO Rick Pollack says hospitals' new lawsuit against HHS looks to "ensure that drug companies provide the transparency and accuracy that the government has found lacking and hold price gouging drug companies accountable."

Pharmacists might not tell you if your drug costs less out-of-pocket. Congress is trying to change that.

September 11, 2018


Senate and House lawmakers are backing legislation that would ban so-called "pharmacy gag clauses" that can prohibit pharmacists from telling patients when their prescription drugs would cost less if they pay out-of-pocket than if they use their insurance.

Health plan premiums will see average 3.6% increase for 2019, analysis finds

September 10, 2018


An analysis by Avalere Health and the Associated Press finds individual health plan premium rates will increase by an average of 3.6% across 47 states and Washington, D.C., for the 2019 coverage year when compared with 2018 premium rates.

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