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What We're Reading: Prohibiting Pharmacist Gag Clauses; Better Overdose Treatment; ACA Lawsuit Fight
New legislation in Congress would prohibit limiting what pharmacists can tell patients about the cheapest way to pay for their prescriptions; drug companies, researchers, and health officials are trying to develop an overdose-reversal treatment that is more successful than naloxone against synthetic opioids; a Texas lawsuit seeking to strike down the Affordable Care Act is being opposed by 16 Democratic attorneys general.
Prohibiting Pharmacist “Gag Clause”
New legislation in Congress would prohibit insurers or pharmacy benefit managers from limiting what pharmacists can tell patients about the cheapest way to pay for their prescriptions. According to The Detroit News, some prescriptions may be cheaper for customers if they pay in cash, rather than their insurance co-pay, but pharmacists were unable to tell them that. The legislation is being sponsored by Senators Debbie Stabenow, D-Michigan, and Susan Collins, R-Maine. Research has shown customers overpay for prescriptions 23% of the time.
Searching for the Next Overdose-Reversal Drug
Naloxone is widely used to reverse opioid overdoses, but it has limited success against synthetic opioids. With the use of synthetic opioids on the rise, drug companies, researchers, and health officials are trying to develop a new treatment that may replace naloxone in certain cases, reported STAT. One option being pursued is tweaking buprenorphine, which is currently used to treat addiction, but may also be able to reverse an overdose with some changes.
Texas ACA Lawsuit Receives Opposition From 16 AGs
A Texas lawsuit seeking to strike down the Affordable Care Act (ACA) has strong opposition from 16 Democratic attorneys general (AGs), led by California AG Xavier Becerra. As a result, there is a showdown between red and blue states with 19 Republican-led states joining Texas’ case, according to The New York Times. Texas’ lawsuit claims the repeal of the individual mandate as part of the Republican tax bill means that the ACA is no longer valid.
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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