ERIC Urges Congress to Deem PBMs Fiduciaries Under ERISA

By Remy Samuels - As pharmacy benefit managers play a significant role in negotiating prescription drug costs for plan sponsors managing health plans, the ERISA Industry Committee has now called on Congress to deem PBMs as fiduciaries under the Employee Retirement Income Security Act. Read Full Article…

HVBA Article Summary

1. Fiduciary Accountability for PBMs: ERIC argues that pharmacy benefit managers (PBMs) should be subject to ERISA’s fiduciary standards, which would mandate them to act in the best interest of plan participants. This shift aims to hold PBMs accountable for practices that can inflate costs for employees and their families.

2. Impact of FTC Findings: Following a Federal Trade Commission report highlighting the opaque practices and significant power of the largest PBMs, ERIC emphasizes that recognizing PBMs as fiduciaries could help mitigate issues related to high drug prices and self-dealing, ensuring fairer dealings in the prescription drug market.

3. Legislative Recommendations: ERIC urges Congress to define specific actions that would establish PBMs as ERISA fiduciaries, proposing that such a classification would enhance accountability and reduce costs associated with prescription drugs by preventing PBMs from prioritizing profits over plan participants' interests.

States ranked by average monthly ACA subsidy per enrollee 

By Jakob Emerson - West Virginia residents who receive health coverage on the ACA exchange receive the largest premium subsidies on average, while Minnesota residents receive the least, according to an analysis from KFF. Read Full Article…

HVBA Article Summary

1. National Average and Availability: The average monthly advanced ACA premium tax credit across the United States is $536, with these tax credits set to remain available until the end of 2025.

2. Highest State Subsidies: West Virginia leads the states with the highest average monthly subsidy per enrollee at $1,038, followed by Alaska ($867) and Wyoming ($864), indicating significant regional disparities in support.

3. Lowest State Subsidies: At the lower end of the scale, states like Minnesota ($350) and New Hampshire ($352) receive the least in average monthly ACA subsidies, highlighting a gap in financial assistance across the country.

Health care is top of mind as voters prepare to head to polls, survey finds

By Alan Goforth - It is not surprising that a majority of American voters in a new eHealth survey say health care will be one of their top three issues in the upcoming election. However, several of the findings were unexpected by researchers. Read Full Article…  _{(Subscription required)}

HVBA Article Summary

1. Bipartisan Concern Over Health Care Costs: The survey reveals a strong, shared sentiment across party lines regarding rising health care costs, with 88% of respondents expressing shock over their increases in the past four years. Key pain points include higher health insurance premiums (72%) and escalating prescription drug prices (49%).

2. Health Care as a Voting Priority: More than 80% of respondents rank health care as a critical issue for the upcoming presidential election, with 35% considering it their top priority and 50% including it among their top three. Respondents emphasize the need for the next president to focus on Medicare sustainability (59%) and the general cost of medical care (57%).

3. Support for Systemic Changes: A significant majority of voters (60%) support repealing the Affordable Care Act, with a surprising consensus among both Democratic and Republican voters. Additionally, over 80% of respondents favor a single, government-run health care system, indicating a shift in priorities that transcends typical political divides.

US ranks last on key health care measures compared with other high-income nations, despite spending the most, report says

By Jacqueline Howard - The US spends more on health care than any other high-income country, but a new report suggests that “Americans are sicker, die younger and struggle to afford essential health care.” Read Full Article…

HVBA Article Summary

1. Poor Health Outcomes and High Spending: The United States ranked last among ten high-income nations in health care performance, with lower life expectancy, higher rates of death and disease, and significant barriers to accessing care, despite spending the most on health care.

2. Inequities and Administrative Challenges: The U.S. faces substantial disparities in health care access and outcomes, particularly affecting lower-income populations. It also ranks last in administrative efficiency, with complex insurance systems leading to difficulties for both patients and providers.

3. Potential Solutions and Lessons Learned: The report suggests that the U.S. could improve its health care system by expanding insurance coverage, enhancing primary care accessibility, and investing in social determinants of health. Lessons from countries with higher rankings highlight the benefits of universal coverage and streamlined health care processes.

Cap on outpatient hospital costs proposed in new N.Y. bill

By Dan Clark - When a medical practice is purchased and merged with an existing hospital network, there is no law or regulation that requires prices to stay the same for its existing patients. Read Full Article… 

HVBA Article Summary

1. Legislative Proposal: A new bill aims to cap outpatient service charges at 150% of Medicare rates, allowing patients to sue if these limits are exceeded. This legislation, sponsored by state Sen. Liz Krueger, is projected to save New Yorkers over a billion dollars annually by addressing the rising costs linked to hospital consolidations.

2. Rising Healthcare Costs: Research highlights that commercial prices for outpatient services have skyrocketed, with hospital outpatient department prices increasing by 27% from 2017 to 2022, while prices at doctors' offices rose only 2%. This trend indicates that patients may be charged significantly more for services that could be performed in lower-cost settings.

3. Impact of Consolidation: The increasing consolidation of hospital networks leads to higher billing practices, as seen in examples like the median price of an MRI, which is $690 at a doctor’s office compared to $1,422 billed through an outpatient hospital department. Lawmakers aim to enhance transparency and protect consumers from surprise billing, pushing back against the financial strain on patients and workers.

Bipartisan telehealth extension bill passes in House committee

By Noah Tong - As expected, the Telehealth Modernization Act of 2024 advanced out of the House Committee on Energy and Commerce Sept. 18 in a wide-ranging markup hearing. Read Full Article…

HVBA Article Summary

1. Extension of Telehealth Provisions: The legislation extends critical telehealth provisions initially implemented during the COVID-19 pandemic for two years, improving access to services for non-English speakers and rural Americans, and allowing for virtual specialty care and audio-only coverage for those with limited internet access.

2. Support for Individuals with Disabilities: The Ensuring Access to Medicaid Buy-in Program Act of 2024 removes restrictions for adults with disabilities, facilitating access to home and community-based services, and ensuring military families can maintain care for children with disabilities when relocating.

3. Reforms in Healthcare and Oversight: The bill includes measures to enhance transparency for pharmacy benefit managers (PBMs) and requires state Medicaid programs to verify provider status quarterly, as well as the Chronic Disease Flexibility Coverage Act, which expands preventive care services under high-deductible health plans.

GLP-1s could prevent 34K strokes, heart attacks annually: Report

By Paige Twenter - Wegovy and similar medicines have the potential to significantly reduce the risk of strokes and heart attacks in "clinically silent patients," according to research from Dandelion Health. Read Full Article…

HVBA Article Summary

1. Study Overview: Dandelion Health utilized real-world data and clinical AI to explore the potential of GLP-1 receptor agonists, like Wegovy, as a primary preventive treatment for the 44 million obese Americans with mild to moderate cardiovascular disease.

2. Trial Results: In a phase 3 trial, Wegovy demonstrated a 20% reduction in major adverse cardiovascular events and alleviated heart failure symptoms in patients with severe cardiovascular disease, expanding its indications for use.

3. Potential Impact: The research suggests that if the additional 44 million "clinically silent" patients used GLP-1s, approximately 17,300 heart attacks and 16,700 strokes could be prevented annually, highlighting the drug's broader cardiovascular benefits beyond its current eligibility of 6.2 million Americans.