Industry News
News for Insurers
Top stories summarized by our editors
7/23/2021

Colorado's prescription drug monitoring program, which tracks and monitors prescriptions of controlled substances, is doing little to prevent doctor shopping, according to the Office of the State Auditor. The audit found most pharmacies don't submit data within one business day as required, the PDMP database isn't being used to identify overprescribing or to refer suspicious prescribers and pharmacies to law enforcement officials, and the system doesn't track queries for second prescriptions.

7/23/2021

AHIP and 13 other health care organizations outlined their support for a bill intended to advance Medicare's shift to value-based care. The legislation would extend advanced alternative payment model incentive payments, initiate a study of crossover among various Medicare APMs, and require a report comparing health outcomes and racial disparities among beneficiaries covered by an ACO with those who are not assigned to an APM.

7/23/2021

Improving health care and vaccine equity, expanding health care coverage, and reducing prescription drug prices are AHIP's top priorities this year, AHIP President and CEO Matt Eyles said in an interview. Eyles said health system and physician practice consolidation continues to put affordability at risk, and he said health insurance providers are navigating several challenges, including the consequences of deferred care during the COVID-19 pandemic.

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Becker's Payer Issues
7/23/2021

A study in the journal Critical Reviews in Food Science and Nutrition found that the risk for coronary heart disease increases by 9% for every 1.75 ounces of beef, pork or lamb eaten, and by 18% for every 1.75 ounces of meats like bacon, sausage and ham eaten. The study, based on a meta-analysis involving more than 1.4 million individuals, did not find a link between consumption of poultry and higher odds for CHD.

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CNN
7/23/2021

In the latest episode of AHIP's The Next Big Thing in Health podcast, Dr. Johanna Vidal-Phelan, UPMC Health Plan's senior medical services director of quality and pediatrics, discussed how the insurer is reaching the Latino community, which has been hit hard by the pandemic, with accurate COVID-19 information. Initiatives include providing pandemic-related information in Spanish and working with a local nonprofit to bring COVID-19 vaccines directly to the Spanish-speaking community.

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AHIP blog
7/23/2021

Endo International reached a $35 million settlement deal with Tennessee local governments to resolve a lawsuit accusing the firm of downplaying the risks of its Opana ER painkiller and playing a role in the opioid crisis. Endo said the settlement still needs to be approved by some of the plaintiffs, which include 18 cities and nine counties in Tennessee and a "Baby Doe" reportedly born addicted to painkillers.

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Reuters
7/23/2021

The Missouri Supreme Court overturned a lower court decision that blocked implementation of a voter-approved Medicaid expansion in the state. The move will make Missouri the 38th state to expand Medicaid eligibility, and an estimated 275,000 people are expected to gain coverage.

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The Hill
7/23/2021

The Senate Judiciary Committee will consider proposed legislation next week aiming to ban patent settlement deals that delay market entry of lower-cost generic or biosimilar drugs. The Federal Trade Commission estimated the deals cost Americans $3.5 billion a year in 2003, and a more recent analysis by the Center for Innovation estimated they cost between $6.4 billion and $36 billion each year.

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MedCity News
More Summaries:
Senate Judiciary Committee
7/23/2021

Pfizer is investing $650 million in cash and $350 million in equity to commercialize a protein-degrading drug for breast cancer by Arvinas. The companies will split development costs and profits equally, Arvinas stands to gain another $1.4 billion for meeting regulatory and commercial milestones, and Pfizer will test the drug in combination with Ibrance.

7/23/2021

Santa Fe, N.M.-based Christus St. Vincent Hospital agreed to pay $563,809 to resolve allegations of fraudulent health care billing. Authorities said Arthur Caire, a physician employed by the hospital, caused the submission of fraudulent claims for payment to multiple federal health care programs, including the Federal Employees Health Benefit Program, Tricare, Medicaid and Medicare from October 2013 to April 2020.

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Department of Justice