Generics holding down health care spending | Preferred networks do not skimp on quality, study finds | CMS allows limited flexibility in Medicaid expansion plans
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September 8, 2014
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Generics holding down health care spending
The CMS has released a new estimate for U.S. health care spending in 2019 that is $500 billion less than a previous projection, and the Congressional Budget Office has reduced its five-year projections as well. The Bipartisan Policy Center's Steve Bell said greater use of generic drugs is a contributing factor. "We do see drug costs starting to increase again. It's going to be hard to deny payment for new highly expensive drugs that are coming out for some types of cancer and hepatitis C," Bell said. Bloomberg (9/5)
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Preferred networks do not skimp on quality, study finds
Health plans that establish a network of preferred providers can keep patients' costs up to one-third lower than unlimited plans while still offering access to equally good hospitals and care, according to research by health economist Jon Gruber. Vox (9/8)
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Legislative & Regulatory News
CMS allows limited flexibility in Medicaid expansion plans
The CMS has allowed some states to expand Medicaid eligibility under the Affordable Care Act using Section 1115 waivers but has rejected certain proposals, such as requiring that newly eligible enrollees who are unemployed be actively searching for work. MedPage Today (free registration) (9/5)
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Feds crack down on overmedication in nursing homes
The U.S. attorney for the Northern District of California is suing two nursing homes for allegedly inappropriately administering drugs to patients. The two nursing homes received about $20 million from Medicare and Medicaid for services that the lawsuit alleges were inadequate, substandard or worthless. National Public Radio/Shots blog (9/5)
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White House selects new U.S. tech chief
Megan Smith, vice president of Google X research lab, was tapped by the White House to replace Todd Park as the country's chief technology officer. As the country's new technology chief, Smith will "accelerate attainment of the benefits of advanced information and communications technologies," according to a blog post by senior White House adviser John Holdren. The White House also tapped Alex Macgillivray, former general counsel at Twitter, to become the U.S. deputy CTO. The Hill (9/4)
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Advocates push to enroll rural residents in health plans
People who live in rural areas face challenges enrolling in health plans under the Affordable Care Act, including needing to travel long distances to get help and having spotty Internet coverage, researchers say. Rural enrollment is especially low in states that did not expand Medicaid eligibility and did not set up their own insurance marketplaces. HHS has allocated $60 million for insurance navigators in states using HealthCare.gov for 2015 enrollment, but it is not known how much will be spent on enrolling rural residents. Kaiser Health News (9/8)
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PBM Industry News
Iowa PBM law violates federal law, PCMA suit argues
An Iowa law that authorizes the state insurance commissioner to require pharmacy benefit managers to disclose pricing data is preempted by the federal Employee Retirement Income Security Act, according to a lawsuit filed by PCMA. Moreover, the law would increase drug prices for employers, unions and publicly funded drug plans, PCMA says. Healthcare Payer News (9/4)
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SmartQuote
Progress is impossible without change, and those who cannot change their minds cannot change anything."
-- George Bernard Shaw,
Irish playwright
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About PCMA
PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 216 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D. PCMA is dedicated to enhancing the proven tools and techniques pioneered by PBMs that generate savings and access for consumers and payors.

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