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What We’re Reading: FFS Medicare Savings; ICU Triage Discrimination; Pfizer, Moderna Patent Lawsuits
Medicare Advantage plan members could save $12 billion if enrolled in fee-for-service (FFS) plans instead; Black patients were classified as low priority for intensive care unit (ICU) triage twice as often as other patients; Moderna and Pfizer face lawsuits over potential COVID-19 vaccine patent infringement.
FFS Medicare Plans Could Have Brought More Savings
A MedPAC report on Medicare payment policy concluded that enrolling beneficiaries in fee-for-service (FFS) plans instead of Medicare Advantage (MA) plans could have saved the government billions. Previously, MA risk scores were about 9.5% higher than scores for beneficiaries enrolled in FFS plans. By law, CMS reduced the MA risk scores by 5.9% to be 3.6% higher than FFS beneficiaries, which led to $12 billion in excess payments for MA plans. Increasing diagnostic coding could allow for plans to offer more benefits and attract more enrollees, the report authors noted. Their report satisfied 4 additional legislative mandate that address adjustments to certain payment systems, the performance of specialized MA plans, and a value incentive program for postacute care services.
Black Patients With COVID-19 Given Lowest ICU Priority
According to CIDRAP News, a crisis-standards-of-care (CSOC) scoring system assigned twice the proportion of Black patients to the lowest priority group for triage treatment for COVID-19 within an intensive care unit (ICU). The disparities were found in a modeling study that analyzed the link between CSOC systems—with estimated deaths by race, ethnicity, and residence—among 498 adults admitted to an ICU at 1 of 6 hospitals in Boston. During the pandemic, health systems adopted CSOC scoring systems to allocate limited medical resources, including ventilators. Relative to other participants (8.1%), 15.2% of Black patients were classified into the lowest priority group. Additionally, allocation for ventilators for high-priority patients showed 43.9% excess deaths among Black patients vs 28.6% among all other patients.
Alnylam Sues Pfizer, Moderna for Patent Infringement
Alnylam Pharmaceuticals filed 2 lawsuits in Delaware federal court against Pfizer and Moderna, alleging the companies infringed on patents surrounding the manufacture and sale of their respective messenger RNA vaccines. According to Reuters, Alynylam is seeking damages for the companies’ use of its lipid nanoparticles technology that’s used to carry and deliver RNA-based therapies and vaccines in patients. The suit comes after Arbutus Biopharma Cop sued Moderna in February, claiming that Moderna infringed on its patents for vaccine manufacturing. Anlnylam states that it does not plan to take any actions that would halt or slow the production, sale, or distribution of the vaccines to patients worldwide.
Generic Drug Savings Possibilities: $3.6 Billion to Medicare Using DTC Pricing
June 22nd 2022How much would have Medicare saved if it had the same ability to purchase generic drugs at the same price as individuals using direct-to-consumer (DTC) pharmacies like the Mark Cuban Cost Plus Drug Company? Billions, as it turns out.
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Health Equity & Access Weekly Roundup: January 11, 2025
January 11th 2025ACA enrollment rate hits a milestone, though IRA subsidies may not extend beyond 2025; network adequacy standards fail to translate into efficient access to mental health care for Medicaid enrollees; research examines racial disparities in postpartum hypertension and vaccine uptake.
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Investigating How Care Fragmentation May Affect Primary Care Redesign in Medicare
March 20th 2022On this episode of Managed Care Cast, Lori Timmins, PhD, and Eugene Rich, MD, discuss the findings of their interim analysis of data from the first 3 years of the Comprehensive Primary Care Plus Initiative, a large-scale effort of primary care redesign meant to improve care fragmentation among Medicare fee-for-service beneficiaries.
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Year-End Spending Bill to Feature Reforms for Pharmacy Benefit Managers and Telehealth Access
December 18th 2024The health care provisions include key reforms targeting pharmacy benefit managers, extensions of Medicare telehealth flexibilities, and measures aimed at combating the opioid crisis and preparing for future pandemics.
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