Opting Out of Medicaid Cuts
Certain states may have the opportunity to opt out of Medicaid cuts under the Senate’s new bill to repeal the Affordable Care Act. According to Politico, Alaska, Wyoming, South Dakota, North Dakota, and Montana may be able to delay the new Medicaid financing system in the bill based on their low-density populations. The rest of the states would be moved to the bill’s block grant payment system. The opportunity to opt out would expire in 2026. Alaska’s governor has come out against the bill, while Senator Lisa Murkowski, who voted against previous repeal bills, is currently undecided.
Amazon Is in Talks With PBMs
There have been rumors for a while that Amazon might be looking to get into the pharmaceutical business. Now there are reports that the retail giant is in talks with mid-size pharmacy benefit managers (PBMs) to set up contracts, according to FiercePharma. Amazon could also decide to become an online pharmacy, an integrated PBM, or a distributor for pharmacies. Amazon’s entry into the field could take 18 to 24 months and would significantly shake up the drug business.
Safety Net Hospital Payments at Risk
Hospitals are currently reimbursed for some of the costs they incur from taking care of uninsured patients or those who cannot afford their medical bills through a federal program that is now at risk of expiring. The Disproportionate Share Hospitals payments offset some of the uncompensated care hospitals provide, but a payment cut is slated for October 1, reported STAT. If Congress doesn’t act, a total of $43 billion in payment cuts will start to take effect. Safety net hospitals, which care for some of the most vulnerable populations, will be hit the hardest.
Ibrutinib Benefits R/R CLL, but Combo Therapy Works Better
March 5th 2025Ibrutinib remains a key treatment for relapsed chronic lymphocytic leukemia (CLL), but findings suggest that combining it with other therapies can improve response rates and may allow for treatment discontinuation in some patients.
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Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care
February 25th 2025On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.
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Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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More than 5 years after the American Society of Clinical Oncology warned of emerging disparities in precision medicine, efforts by community practices to embrace technology, form partnerships, and use data show how patients can gain access to personalized approaches. But challenges remain, especially for those covered by Medicaid.
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