Late last summer Pamela Ludwig, owner of a Franklin, Tennessee firm that goes by the name Pretty in Pink Boutique, began receiving calls from angry Medicare enrollees across the country. The seniors were mad that their Medicare accounts had been charged for urinary catheters they did not need, nor had received. About the same time 1,300 miles away in El Paso, Texas Erika Tavarez too began receiving angry emails and then a visit from the FBI. She had recently sold a durable medical equipment business, also called Pretty in Pink, that provided prothesis for breast cancer survivors.
Category: Medicare
Congress Wants to Reform Pharmacy Benefit Managers
Pharmacy Benefit Managers (PBMs) have been portrayed as a boogeyman for quite some time. PBMs manage drug benefits for health plans, including employee health plans, Obamacare, Medicare Advantage, Medicaid managed care and private insurers. PBMs raised the ire of independent pharmacies years ago because PBMs bargain down the fees pharmacists receive from government programs like Medicaid. For instance, most state fee-for-service (FFS) Medicaid programs pay small pharmacies dispensing fees that exceed $10 for a prescription, while some states pay small dispensing fees of more than $13 a prescription, while others pay more than $15. Dispensing fees are the professional fees (basically for counting pills and placing them in a bottle) in addition to the ingredient costs. Keep in mind that Walmart will dispense a month’s supply of certain generic drugs for a total cost of $4, a fee that includes the dispensing fee and the cost of the drugs themselves. Paying $15 to $20 for a Medicaid FFS prescription that Walmart sells to uninsured consumers for $4 seems excessively generous.
Mission Creep: Housing for Homeless is Another Medicaid Expansion
Some states have begun a novel experiment: diverting health care funds for housing assistance.
States are plowing billions of dollars into a high-stakes health care experiment that’s exploding around the country: using scarce public health insurance money to provide housing for the poorest and sickest Americans.
At last count nearly 40% of states – 19 so far – are diverting funds from Medicaid into housing assistance. The Biden Administration is encouraging others to follow.
Saturday Links
- More evidence that genes trump social factors in explaining behavioral outcomes.
- CDC: The new Covid vaccine is 54% effective.
- Len Schaeffer:
The level of variation in our health care system is unbelievable. You could be hospitalized for nine days in New York and for three days in California with the same diagnosis—and those differences would have no impact on outcomes. There is no other industry in the world that uses so many different approaches to the same thing and in which these differences don’t relate to better results. (Article is interesting throughout)
- “Imagine an integrated device that includes an insulin pump, a glucometer, and software that uses photos from a smartphone to carb count your food and dose insulin… The FDA’s regulatory framework is ill-equipped to deal [with this].”
- Is there a relationship between Medicaid expansion and the opioid crisis?
- The US has 36 million Health Savings Accounts, covering 72 million people.