Telehealth Waiver Bill Moves Forward

By Center for Connected Health Policy - On September 18, 2024, the House Energy and Commerce Committee marked up and passed out of Committee HR 7623, the Telehealth Modernization Act of 2024.  The next stop for the bill will be the House floor and then, if passed, it will be sent over to the Senate. Read Full Article… 

HVBA Article Summary

1. Extension of Medicare Telehealth Waivers: The bill proposes to extend current Medicare telehealth waivers for an additional two years, moving the expiration date from December 31, 2024, to December 31, 2026. This will maintain access to telehealth services for a wider range of providers and allow services to be delivered regardless of location.

2. Acute Hospital Care at Home Flexibilities: The Acute Hospital Care at Home waiver flexibilities will be extended for five additional years, until 2029. This includes requirements for studies to evaluate the program’s outcomes and costs based on different patient entry points.

3. Requirements for Telehealth Billing: The bill mandates that the Secretary of Health and Human Services establish requirements for modifiers in telehealth billing by January 1, 2026, particularly for practitioners using virtual platforms and billing services incident to their professional services.

PBMs' trade group slams FTC's insulin 'greed' lawsuit

By Allison Bell - The Pharmaceutical Care Management Association, pharmacy benefit managers' trade group, says the Federal Trade Commission's attack on PBMs' role in negotiating insulin prices is the result of a biased, anti-industry investigation. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. FTC Allegations: The FTC has filed an administrative complaint against major pharmacy benefit managers (PBMs)—CVS Health's Caremark Rx, Cigna's Express Scripts, and UnitedHealth's OptumRx—alleging that their anticompetitive rebating practices have led to artificially inflated list prices for insulin drugs.

2. Price Trends and Market Dynamics: According to IQVIA, the average out-of-pocket cost for a 30-day supply of insulin has decreased from $25.79 in 2019 to $18.64 in 2023, suggesting that market mechanisms may be functioning effectively in response to pricing pressures and legislative scrutiny.

3. Influence of Patent Abuse: The high cost of insulin is partly attributed to drug patent abuse, where manufacturers extend patent protections on insulin drugs beyond their original expiration, hindering competition and keeping prices elevated despite recent price reductions following public and congressional attention.

Novo Nordisk CEO grilled by Congress over Ozempic, Wegovy prices in US

By Kristin Garris’s - For the millions of people living with diabetes or obesity, drugs like Ozempic and Wegovy can significantly improve their health. Read Full Article…

HVBA Article Summary

1. High Out-of-Pocket Costs vs. International Prices: Patients in the U.S. face significant out-of-pocket expenses for Ozempic (over $950 per month) and Wegovy (over $1,300), while these drugs are much cheaper abroad, costing $155 in Canada and $59 in Germany.

2. Blame Game in Pricing: During a Senate hearing, Novo Nordisk's CEO Lars Jørgensen emphasized that his company does not set prices directly; instead, prices are determined through negotiations with Pharmacy Benefit Managers (PBMs). He expressed support for government negotiations to improve affordability but warned against price-setting that could harm innovation.

3. Industry Responses and Legislative Challenges: The Pharmaceutical Care Management Association (PCMA) defended PBMs' role in managing drug costs, while America’s Health Insurance Plans (AHIP) criticized drugmakers for maintaining high prices. Lawmakers are tasked with balancing the need for affordable drug prices with the profit incentives necessary for pharmaceutical innovation.

Healthcare Leaders: Tech’s Possibilities And The Industry’s Barriers

By Glenn Llopis  - Digital technology can support the mission of improving people’s lives, but it’s not the end in and of itself. Read Full Article… 

HVBA Article Summary

1. Human Connection is Essential: Healthcare is fundamentally a human business, emphasizing the importance of personal connections between patients and providers. While digital technology can facilitate access to care, it should not replace the human interaction that patients value.

2. Challenges in Personalization: Despite advancements in digital health technologies, there remains significant room for improvement in personalizing patient experiences. Many current systems, like electronic medical records, can hinder rather than help personalization efforts.

3. Balancing Technology and Resources: Organizations face challenges in implementing new technologies due to limited resources and uncertain insurance reimbursements. Effective patient monitoring and engagement tools, like Zimmer Biomet's mymobility, show potential but require sufficient support and integration within healthcare systems.

Do You Have to Enroll in Medicare at 65 if You're Still Working?

By Peter Butler and Jason Chun - If you're approaching 65 years of age in the US, you've likely been thinking about Medicare -- the federal program that helps provide health care coverage to senior citizens and people with disabilities. Read Full Article… 

HVBA Article Summary

1. Eligibility and Enrollment Requirements: Most Americans are required to enroll in Medicare when they turn 65, but those with employer-based health insurance from companies with over 20 employees may delay enrollment until their insurance ends. If you work for a smaller company, check with HR, as some require Medicare enrollment.

2. Parts of Medicare: Medicare consists of several parts: Part A (hospital insurance) and Part B (medical insurance), both of which have associated costs. Part C (Medicare Advantage) and Part D (prescription drug coverage) are optional plans that provide additional benefits and must be purchased separately.

3. Penalties for Late Enrollment: Delaying enrollment in Medicare can result in permanent penalties, such as increased monthly premiums for Part B and Part D. For Part A, the penalty is 10% of the premium for twice the number of years you delay, while Part B incurs a 10% penalty for each year of delay, lasting for as long as you receive benefits.

Creating benefits that care for the whole employee

By Lee Hafner - Employers are on a never-ending quest to build benefits options that make healthcare more efficient and personalized. Looking at the entire spectrum of employee wellness and how to best reach them with solutions is a necessary part of this. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Evolution of Benefits Design: Dlugolenski highlighted a significant shift from one-size-fits-all benefit plans to more personalized and targeted solutions that address specific health and financial needs of employees, such as specialized programs for diabetes, fertility, and mental health.

2. Importance of Targeted Engagement: She emphasized the necessity of effectively reaching employees with the right solutions at the right time and through appropriate channels, noting that traditional methods (like newsletters) are insufficient for driving engagement and demonstrating ROI.

3. Budgeting and Flexibility: Dlugolenski pointed out that employers must start with data to assess their budget and priorities, and work collaboratively with partners to create a benefits package that evolves through trial and error, stressing the importance of benchmarking against industry standards.

Nearly two-thirds of Americans fear Medicare will not be there when they need it

By Nationwide - Americans are increasingly concerned about the future of Medicare, with nearly two-thirds (63%) fearing the program will not be there when they need it, according to the annual Nationwide Retirement Institute® Health Care Costs in Retirement survey. When asked about their biggest retirement planning stressor, one in five (20%) selected Medicare running out of money. Read Full Article…

HVBA Article Summary

1. Public Concerns About Medicare: With rising fears over Medicare's long-term solvency, 42% of Americans believe ensuring its stability should be a top priority for the next administration, closely following the desire to lower out-of-pocket costs and prescription drug prices (both at 43%). This sentiment is shared across party lines, with significant bipartisan support for Medicare reforms.

2. Financial Stress from Health Care Costs: Many Americans face financial anxiety due to health care expenses, with 67% worried that a single health crisis could jeopardize their finances. A considerable number report that medical costs have severely impacted their ability to save for retirement, underscoring the need for effective financial planning.

3. Importance of Financial Guidance: Despite a majority expressing the need for expert financial advice regarding health care costs in retirement, two-thirds do not currently work with financial professionals. Many lack understanding of Medicare and its implications for retirement planning, highlighting a crucial gap that needs to be addressed to secure financial futures.

Employees stress on the rise as wellness benefits become more inaccessible

By Lucy Peterson - Many U.S. employees report high stress levels as a result of their jobs and there is not enough adequate communication around the wellness benefits available to them. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Prevalence of Stress and Burnout: A report by Firstup found that 60% of stressed working adults attribute their stress to their jobs, leading to significant burnout (55%), diminished motivation (48%), and poor work performance (37%).

2. Underutilization of Wellness Programs: Despite the need for employee wellness programs, over one-third of respondents reported that their organizations do not offer such resources. Among those that do, only 28% utilize the programs, highlighting a gap between available benefits and employee engagement.

3. Communication Gaps in Wellness Benefits: A quarter of employees are unaware of where to find wellness benefits information, with 15% uncertain about the existence of such programs. The report suggests organizations should enhance communication strategies, particularly for deskless workers, by using mobile and integrated platforms like Microsoft Teams or Slack to increase accessibility.