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What We're Reading: Kentucky PBMs Reap Spreads; Papers Point to Purdue Deception; Kansas Farm Bureau Health Plan
Pharmacy benefit managers (PBMs) took $123.5 million in spread pricing from Kentucky Medicaid plans, according to a state report; Richard Sackler, MD, the former president of OxyContin maker Purdue Pharma, repeatedly gave testimony in an opioid lawsuit that conflicts with a federal report, according to court papers; rural state lawmakers in Kansas are pushing a plan to allow the Farm Bureau to offer health insurance coverage, but Democrats and others are critical of the idea.
Kentucky PBMs Took $123.5 Million in Spread Pricing From Medicaid Program, Report Says
Court Papers Show Former Purdue President Tried to Hide Potency of OxyContin
Rural Lawmakers Push Health Insurance Coverage From Kansas Farm Bureau
Pharmacy benefit managers (PBMs) took $123.5 million in spread pricing from Kentucky Medicaid plans, according to a state report. Bloomberg reported that 4 Kentucky insurers in Medicaid paid $957.7 million to 4 PBMs that use the arrangements last year. Of that, the PBMs kept 13% through spread pricing, and the size of the spreads rose by more than a third from 2017, the state found. Reports from other states have found similar patterns.Richard Sackler, MD, the former president of OxyContin maker Purdue Pharma, repeatedly gave testimony in an opioid lawsuit that conflicts with a federal report, according to court papers obtained by ProPublica and STAT News. The court papers that indicate Sackler endorsed marketing efforts to conceal the opioid’s strength from physicians as soon as a year after the drug's 1996 launch. During a previous pretrial deposition he said he first learned from a Maine newspaper article in 2000 that the painkiller was being abused.Rural state lawmakers in Kansas are pushing a plan to allow the Farm Bureau to offer health insurance coverage to members without having to comply with Affordable Care Act mandates in hopes that the agriculture group's plan will have a lower price, the Associated Press reported. But the proposal is drawing strong criticism from Democrats and health groups because a Farm Bureau plan would not be required to cover people with pre-existing medical conditions.
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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