Democrats unveil ACA tax credit plan, teeing up next health-care fight

By Dan Diamond - Democrats on Wednesday launched a legislative push to extend federal subsidies that defray the cost of health insurance for millions of Americans. The effort tees up another Affordable Care Act fight that could stretch into next year — and perhaps challenge the next president. Read Full Article… 

HVBA Article Summary

1. Legislation Introduction: Senators Jeanne Shaheen and Tammy Baldwin, alongside Representative Lauren Underwood, introduced legislation to make permanent the enhanced premium tax credits (PTCs) under the Affordable Care Act, aimed at reducing healthcare costs for millions of Americans. This initiative has strong support from Democratic leaders, including President Biden and Vice President Harris, who have committed to ensuring these tax credits remain in place.

2. Financial Implications and Support: The Congressional Budget Office estimates that making these tax credits permanent would provide health coverage to millions but would also cost the federal government about $335 billion over the next decade. Supporters argue that these credits have significantly expanded health coverage, while opponents, primarily Republicans, criticize them as a costly federal giveaway that distorts the ACA’s original purpose.

3. Political Landscape and Urgency: The debate over the tax credits reflects broader political tensions regarding the future of the ACA. With the potential expiration of the credits set for 2025, lawmakers are urged to act swiftly to prevent premium spikes and coverage losses. However, significant opposition from Republicans, who view the subsidies as unsustainable and problematic, complicates the legislative process.

Ozempic linked to lower opioid overdose rate in those with diabetes, study shows

By Lev Facher - People taking semaglutide medications like Ozempic for diabetes may be at reduced risk of drug overdose, according to new research. Read Full Article…

HVBA Article Summary

1. Link Between Semaglutide and Lower Overdose Rates: A study indicates that prescriptions for semaglutide, including Ozempic and Rybelsus, are associated with significantly lower opioid overdose rates among patients with type 2 diabetes and opioid use disorder, highlighting the potential of these medications beyond their primary use as appetite suppressants.

2. Need for Further Research: Despite the promising association, researchers, including Nora Volkow from the National Institute on Drug Abuse, emphasize that the relationship between GLP-1 drugs and overdose prevention remains unclear, necessitating more rigorous studies, such as randomized controlled trials, to establish definitive conclusions.

3. Potential Role in Addressing the Opioid Crisis: The findings suggest that GLP-1 medications could be a valuable alternative for patients with opioid use disorder, particularly in light of the ongoing overdose epidemic, although challenges remain regarding accessibility, cost, and the need for more comprehensive understanding of the drugs' effects.

'Stop ripping us off,' says Sen. Sanders, but Novo CEO blames PBMs for high Wegovy prices

By Allison Bell - Ozempic and Wegovy have high prices in the United States because U.S. pharmacy benefit managers like high-cost drugs, according to Lars Fruergaard Jørgensen, the chief executive officer of Novo Nordisk. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Impact of PBMs on Pricing: Jørgensen highlighted that pharmacy benefit managers (PBMs) influence drug pricing strategies by favoring high list prices, as they earn more fees tied to the savings generated for payers. This practice leads Novo Nordisk to set higher list prices for its drugs, like Ozempic and Wegovy, as those with lower prices tend to receive less coverage.

2. Complex U.S. Pricing System: The U.S. pricing structure complicates price comparisons with other countries, with Novo Nordisk receiving a smaller portion of revenue from U.S. sales (about 24%) compared to European markets. Despite higher prices for consumers, the company's revenue from U.S. patients is often lower than from European counterparts due to the significant rebates and discounts paid to PBMs.

3. Proposed Solutions and Market Challenges: Jørgensen suggested that PBMs should consider charging a flat fee per prescription instead of basing fees on negotiated discounts, which could lead to more equitable pricing. He also emphasized the challenges of competing in the insulin market, as falling prices and PBM practices create barriers for new entrants, leading to the suspension of production for certain drugs like Lemira.

HHS watchdog flags potential remote monitoring fraud. Stakeholders say concerns about misuse are overblown

By Emma Beavins - The Department of Health and Human Services’ Office of the Inspector General clarified that it wants remote physiologic monitoring to continue, despite its report that prods Medicare to develop more oversight for billing. Read Full Article… 

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1. Concerns Over Accuracy and Potential Impact: Experts have criticized the OIG’s September report on RPM, claiming it contains inaccuracies and subjective statements that could jeopardize the future of the service. The Alliance for Connected Care formally requested a retraction, arguing that the report’s findings are misleading and fail to highlight reasonable claims about RPM practices.

2. Questionable Billing Practices: The OIG report raises concerns about billing patterns for RPM, noting that a significant percentage (43%) of enrollees did not receive all three required components of remote monitoring. This inconsistency has led to suspicions of potential fraud and misuse of billing codes, particularly regarding the treatment management portion of RPM services.

3. Need for Clarity and Guidance: Stakeholders, including legal experts and RPM advocates, emphasize the need for clearer billing guidelines from the Centers for Medicare & Medicaid Services (CMS) to avoid ambiguity in RPM practices. They argue that without specific guidance, providers face challenges in ensuring compliance, potentially leading to confusion about the appropriate billing of RPM services as the demand for such technologies continues to grow.

MHPAEA 2024 Final Rule Requires Action by Plan Sponsors

By Bradley Roehrenbeck, Martha Sewell, and Mark Stember - On September 9, 2024, the Departments of Treasury, Labor and Health and Human Services published the much-anticipated final rule implementing parts of the Mental Health Parity and Addiction Equity Act (MHPAEA). Read Full Article…

HVBA Article Summary

1. Strengthened Compliance and Comparative Analysis Requirements: The final rule mandates that health plans conduct detailed comparative analyses of non-quantitative treatment limitations (NQTLs) to ensure that mental health and substance use disorder (MH/SUD) benefits are treated comparably to medical and surgical benefits. This includes requirements to evaluate and document how NQTLs are applied and to demonstrate that any limitations on MH/SUD benefits are not more restrictive than those on medical/surgical benefits.

2. Meaningful Benefit and Discriminatory Standards: Plans providing MH/SUD benefits must offer "meaningful benefits" across all classifications where medical/surgical benefits are offered. Additionally, the final rule prohibits the use of discriminatory standards in the design and application of NQTLs, ensuring that plans do not systematically disadvantage access to MH/SUD services.

3. Implementation Timeline and Monitoring: The final rule will take effect for plan years beginning on or after January 1, 2025, with some requirements delayed until 2026. Plans are required to collect and evaluate data to monitor for material differences in access to MH/SUD services compared to medical/surgical services and to take reasonable corrective actions when such differences are identified.

Employees Desire Supplemental Health Benefits Amidst Rising Healthcare Costs, New York Life Survey Finds

By Business Wire - As open enrollment season for employees across the U.S. begins, a new survey from New York Life's Group Benefit Solutions highlights the crucial role of supplemental health insurance in employees' financial well-being and overall peace of mind. Read Full Article…

HVBA Article Summary

1. Prevalence of Out-of-Pocket Healthcare Expenses: A significant 57% of employees reported having out-of-pocket healthcare expenses this year that were not covered by their health insurance plan, highlighting the financial burden many are facing.

2. Interest in Supplemental Health Insurance: Supplemental health insurance emerged as a top benefit for employees, with 50% expressing interest in receiving it from their employer. Employees with supplemental coverage also report higher confidence in meeting financial goals and feeling financially secure compared to those without it.

3. Knowledge Gap in Employee Benefits: Less than half of employees feel extremely knowledgeable about their employer benefit plans, with only 34% confident in their understanding of the benefits they need. This suggests a critical need for employers to provide better education and resources during open enrollment to help employees make informed decisions.

Severe obesity is on the rise in the US

By Jonel Aleccia - Obesity is high and holding steady in the U.S., but the proportion of those with severe obesity — especially women — has climbed since a decade ago, according to new government research. Read Full Article…

HVBA Article Summary

1. Obesity Prevalence and Trends: The U.S. obesity rate remains around 40%, with nearly 10% reporting severe obesity, a notable increase from 8% in previous surveys. Despite a slight decrease in the overall rate compared to earlier years, the change is not statistically significant, leaving uncertainty about the impact of new weight-loss treatments.

2. Demographic Variations: The survey revealed disparities in obesity rates based on education, with 32% of individuals holding a bachelor's degree or higher reporting obesity, compared to 45% of those with lower education levels. Additionally, women are nearly twice as likely as men to experience severe obesity.

3. Public Health Concerns and Future Directions: Experts express concern over the rising rates of severe obesity, which is closely linked to serious health issues like cardiovascular disease and diabetes. The focus is shifting towards understanding obesity as a metabolic disease and emphasizing prevention strategies starting in early childhood to address this growing public health crisis.