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What We're Reading: Resuming Risk Adjustment Program; New Endometriosis Drug; Lilly Denounces Drug Imports
The Trump administration said it will restart the risk adjustment payment program just weeks after suspending the payments; the first pill in a decade has been approved to treat pain caused by endometriosis; Eli Lilly executives said during the second quarter earnings call that the idea of importing drugs from abroad was “the wrong road to go down.”
Trump Administration Reverses Decision on Risk Adjustment Payments
The Trump administration said it will restart the risk adjustment payment program established under the Affordable Care Act that pays money to insurers who take on higher-risk patients. According to The New York Times, in reversing the decision, the administration is acknowledging that ending the payments could destabilize the insurance markets. The program was suspended July 8 after a court ruling. CMS’ decision had put $10.4 billion in risk adjustment transfer payments for the 2017 benefit year on hold. Payments will resume around October 22.
New Treatment for Endometriosis Approved
The first pill in a decade has been approved to treat pain caused by endometriosis, a common gynecologic disorder that affects approximately 1 in 10 women of reproductive age. It can cause severe pain and infertility. Testing of the drug found that it significantly reduced menstrual pain in 45% of women on the low dose and in 75% of women on the high dose, reported the AP. Side effects include hot flashes, headaches, and bone thinning. The drug will cost $845 every 4 weeks without insurance.
Eli Lilly Criticizes Trump Administration Drug Importation Proposal
During Eli Lilly’s second quarter earnings call, executives said the idea of importing drugs from abroad was “the wrong road to go down.” The Hill reported that Lilly’s CEO said regulatory reforms would more successfully improve access to prescription drugs and keep prices affordable. He added that he is open to changing the Medicare drug rebate structure, under which drug companies negotiate rebates with insurers or pharmacy benefit managers.
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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