CER Daily Newsfeed

How a Company Makes Millions Off a Hospital Program Meant to Help the Poor

(1/15, Ellen Gabler, The New York Times) reports “...Twenty years ago, the federal government chose Apexus to manage what was then a small program, negotiating with drug distributors and manufacturers to secure better prices and access to medications. But Apexus is allowed to collect a fee for almost every drug sold under the [340B] program, giving the company an incentive to help hospitals and clinics capture as many prescriptions as possible...Government officials have told Apexus to focus solely on administering the program and not to influence drug purchases. But Apexus leaders have sometimes ignored that request, according to two complaints filed with a government watchdog and six current and former employees, speaking on the condition of anonymity.” Subscription Required

Largest Pharmacy-Benefit Managers Hiked Up Drug Prices, FTC Says

(1/14, Joseph Walker and Liz Essley Whyte, The Wall Street Journal) reports “...The markups helped the PBMs reap $7.3 billion from 2017 to 2022, the FTC found...The report analyzed more than 50 so-called specialty generic drugs that are used to treat serious diseases such as cancer, and compared the prices PBMs reimbursed their pharmacies with the average pharmacy acquisition cost for the drugs. ‘This is very significant overcharging, and it is really adding up across the 51 drugs we analyzed,’ said an FTC official...The FTC's analysis included other drugs such as hypertension medications sildenafil and tadalafil, cystic fibrosis inhaler tobramycin, the HIV medicine ritonavir and progesterone injections used to treat infertility.” Subscription Required

Innovation At CMS: Advancing A Person-Centered Health System

(1/15, Elizabeth Fowler, Chiquita Brooks-LaSure, Purva Rawal, Health Affairs Forefront) comments “...Within the ACO REACH model, safety net provider participation doubled between 2022 and 2023 when the model was redesigned with equity as a focus and increased by an additional 25 percent in 2024. And in the newly launched Making Care Primary Model, over 40 percent of participants are [Federally Qualified Health Centers].” Full

Medicare Accountable Care Organizations In 2023: Large Savings With Increasing Value-Based Programmatic Competition

(1/15, Inga Morken, Kylie Brown, Rachel Bonesteel, David Muhlestein, Frank McStay, Robert S. Saunders, Health Affairs Forefront) comments “...The voluntary nature of the MSSP and other value-based payment models can make it difficult to set benchmarks, as organizations that expect to have health care spending above the administrative benchmark would be unlikely to participate. CMS should continue to explore opportunities to meet ACOs where they are, whether by recognition of program maturity and success or by reflecting the needs of a specific patient population or provider type through benchmark reform.” Full

Is ‘Big Data’ the Cure-All for U.S. Healthcare?

(1/15, Peter Bonis and Jim Weinstein, MedCity News) comments “...Let’s apply AI to empower patients so they can make more evidence-based, informed choices while proactively aligning incentives. Medical decisions that are guided by reasoned data can lead to patient care that is more individualized, costs that are better optimized, and equitable outcomes that exceed global standards.” Full