Wednesday, September 22, 2021

Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

It's still early in the nationwide push to get millions of low-income Medicare beneficiaries to sign up for the subsidy that could cover the bulk of their prescription drug expenses. But, as many of us expected, applications are coming in at a trickle. The low-income subsidy is one of the...
As part of the HHS appropriations bill for FY 2006, Congress is moving fast to drop federal funding for erectile dysfunction (ED) drugs in Medicaid, Medicare, and other federal health programs. This makes sense but there is a catch, albeit an unintentional one. Federal law will still require state...
For cash-strapped state governments, the "clawback" is the most controversial and costly provisions of the Medicare Modernization Act (MMA) and the new Medicare prescription drug benefit. Now, as state begin new fiscal years and grapple with the latest Medicaid spending projections, some state leaders are balking at paying the federal...
Medicaid has become a fiscal disaster for states. With spiraling costs, bulging enrollment, and a degree of complex only a quantum physicist could love, Medicaid is in desperate need of large-scale reform. The National Governors Association (NGA) has adopted an interim policy on comprehensive Medicaid reform. The policy, which all...
States continue to serve as laboratories for health care reform. In recent years, many of these state-based efforts have focused on: 1. Leveraging Employer-Based Coverage: With the goal of making health insurance coverage more affordable to small businesses and their employees, state tools include (a) premium assistance, (b) reinsurance to...
The new Medicare prescription drug benefit presents many challenges to the nation's seven million dual Medicare-Medicaid eligibles. On January 1, 2006 they must move from broader, more flexible Medicaid drug coverage to the narrower, extraordinarily complex Medicare drug benefit. Among those in jepordy are about a half million frail...
Many Americans living with HIV/AIDS receive critically important prescription drug coverage from state Medicaid programs. For these beneficiaries, Medicaid typically offers broad formularies, low cost sharing, and access to a large network of pharmacies. However, about 50,000 to 60,000 persons with HIV/AIDS will be losing Medicaid drug coverage on January...
In 2005, state Medicaid programs will pay for over 18 percent of the nation's quarter trillion dollar pharmaceutical market. Thanks to an excellent new analysis by Jim Verdier and colleagues at Mathematica Policy Research, we have new insights into cost and use patterns in Medicaid. Some highlights: ● Average monthly Medicaid...
Medicare observers expect heavy competition for drug plan contracts with the Centers for Medicare & Medicaid Services (CMS). It now appears CMS will receive several hundred applications, including applications from major insurers offering drug benefit packages in every state. Since adoption of the Medicare Modernization Act (MMA), most observers -...
The supply chain for prescription drugs is as complex as it is important. It represents a fascinating, continuously evolving maze of players, relationships, and processes from manufacturers all the way to individual patients. With Medicare's new approach to Part B drug reimbursement, the upcoming Medicare Part D drug benefit, increasing...

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