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What We’re Reading: Cap on ACA Plans; CVS, Walgreens Settle Over Opioids; COVID-19 Diagnoses Rise After Thanksgiving
CMS plans to limit the number of nonstandardized Affordable Care Act (ACA) exchange plans offered by each insurer in 2024; CVS and Walgreens agree to settle on lawsuits revolving around their role in the opioid crisis; cases of COVID-19 rise during the holiday season as people meet with their families.
Limit on Number of ACA Exchange Plans
The Biden administration is looking to limit the number of nonstandardized Affordable Care Act (ACA) exchange plans that an insurer can offer to make it easier for enrollees to pick a plan, according to Fierce Healthcare. The proposal would limit the number of exchange plans offered to 2. The proposal also included plans to lower user fees and make changes to network adequacy standards in 2024. CMS had introduced standardized plan options in 2023 for consumers to choose from in small group markets and HealthCare.gov. CMS had previously expressed concern about the increase in plans that consumers could choose from.
CVS, Walgreens Agree to Settle in Opioid Lawsuit
A combined $10 billion will be paid by Walgreens and CVS in a lawsuit that sought to hold the companies accountable for the opioid crisis, according to The Associated Press. Finalized settlements over opioids have totaled more than $50 billion in recent years, with this current deal from Walgreens and CVS among the largest. Walmart, another pharmacy operator, had agreed to pay $3.1 billion just last month. Most of this money is set to be used to combat the opioid epidemic, which has been linked to more than 500,000 deaths in the United States within the past 2 decades.
Rise in COVID-19 Cases Comes Near the Holidays
State health officials are urging people to get vaccinated before the Christmas holidays as COVID-19 cases rise across the country, according to Politico. Positive tests for COVID-19 have risen 30% since Thanksgiving, and 30,000 patients are in the hospital. Health experts believe that the surge in COVID-19 may be milder compared with years past but worry about how hospitals will cope with the uptick in cases given staffing shortages and the strain of increasing respiratory syncytial virus and flu cases. Only 13% of Americans over the age of 5 years have received their updated booster vaccine.
Urticaria Diagnosis Challenged by Overlapping Pruritic Skin Conditions
April 23rd 2025Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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