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The james Group Newsletter Vol. 5, Num. 10: Association Health Plan, Merck to Lower Drug Prices, KY Resotring Medicaid Benefits, ACA Risk Adjustment Payments, Drug Imports to Counter Price Hikes, UnitedHealth Post Big Profit Jump, CA Rates to Rise 8.7% Next Year, EMR Enhancement of Approved Drugs, Bill Advanced to Halt Employer Mandate, OK Medicaid Approved for Drug Pricing Experiment

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July 23, 2018 

Volume 5, Number 10

In This Issue

Association Health Plan

Merck To Lower Prices For Some Drugs

KY Restoring Medicaid Benefits

ACA Risk Adjustment Payments

Drug Imports to Counter Price Hikes

UnitedHealth Post Big Profit Jump

CA: ACA Rates to Rise 8.7% Next Year

EMR Enhancement of Approved Drugs

House Advances Bill to Halt Employer Mandate

OK Medicaid Approved For Drug Pricing Experiment

TJG On Facebook

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Kaiser Health News: Thinking About an Association Health Plan? Read The Fine Print
If you own a restaurant, plumbing company or other small business, you may be intrigued by the expected expansion of association health plans under a new rule that got a stamp of approval from the Trump administration. Will they meet your needs? Save you money? Those are important questions for small businesses and self-employed people who struggle to buy affordable insurance for themselves and their workers. Federal officials said the new rule would help level the playing field for these businesses, giving the kind of flexibility on benefits and leverage to negotiate with providers that large companies may have. (Andrews, 6/26)

Source: Kaiser Health News

The Hill: Merck To Lower Prices For Some Drugs
The pharmaceutical company Merck on Thursday announced it would lower the costs of some drugs in its portfolio. The company will drop the price of Zepatier, a Hepatitis C drug, by 60 percent, and decrease the costs of "several other" drugs by 10 percent. It also said it would not increase the average net price of drugs in its portfolio by more than inflation annually. (Hellmann, 7/19)

Source: The Hill

The Associated Press: Reversal: Kentucky Restoring Medicaid Benefits For Thousands
Dental and vision care benefits will be restored for hundreds of thousands of Medicaid recipients in a sudden reversal by Kentucky Gov. Matt Bevin's administration following an outcry over the recent cuts. The coverage had been abruptly cut at the start of July after a federal judge rejected the Republican governor's plan to overhaul Kentucky's Medicaid program. The cuts triggered stinging criticism from Democrats and public health advocates. (7/19)

Source: The Associated Press

Bloomberg News: Trump Administration Reportedly Working On A Rule That Would Allow ACA Risk Adjustment Payments To Resume
Bloomberg News reports the Trump Administration is working on “a regulation that would allow the resumption of billions of dollars in payments to health insurers in Obamacare.” On Wednesday, CMS sent the Office of Management and Budget a rule “tied to the risk-adjustment program, which transfers money to insurers who take on sicker customers.” The article adds, “An administration official said the rule is an option being considered to resolve the legal dispute that has held up the payments.” (Tracer, 7/19)

Source: Bloomberg News

The Washington Post: Trump Administration To Explore Allowing Drug Imports To Counter Price Hikes
The Trump administration is cracking open the door to using prescription drugs imported from overseas — ones that have not been approved by the Food and Drug Administration — to combat high drug prices in limited circumstances. The FDA announced on Thursday that it plans to create a working group to examine how to safely import drugs  in a specific situation: when there's a sharp price increase for an off-patent drug produced by a single manufacturer. (McGinley, 7/19)

Source: The Washington Post

The Associated Press: UnitedHealth Posts Big Profit Jump But Sees Room To Improve
UnitedHealth Group easily topped profit expectations during the second-quarter and hiked its outlook for the third time this year, but company shares were punished Tuesday for a performance that even company executives believe falls short of the health insurer's full potential. Enrollment jumped due partially to a surge in government-funded business, and operating earnings soared about 21 percent for the company's fast-growing Optum segment, which strays well beyond health insurance. (7/17)

Source: The Associated Press

California Healthline: California’s ACA Rates To Rise 8.7% Next Year
Premiums in California’s health insurance exchange will rise by an average of 8.7 percent next year, marking a return to more modest increases despite ongoing threats to the Affordable Care Act. The state marketplace, Covered California, said the rate increase for 2019 would have been closer to 5 percent if the federal penalty for going without health coverage had not been repealed in last year’s Republican tax bill. (Terhune and Bartolone, 7/19)

Source: CA Healthline

NPR: Mining Electronic Medical Records To Enhance Use Of Approved Drugs
When you go to your doctor's office, sometimes it seems the caregivers spend more time gathering data about you than treating you as a patient. Electronic medical records are everywhere – annoying to doctors and intrusive to patients. But now researchers are looking to see if they can plow through the vast amount of data that's gathered in those records, along with insurance billing information, to tease out the bits that could be useful in refining treatments and identifying new uses for drugs. (Harris, 7/15)

Source: NPR

The Hill: House Panel Advances Bill That Would Temporarily Halt ObamaCare's Employer Mandate
The House Ways and Means Committee on Thursday approved legislation that would chip away at ObamaCare, including a measure that would temporarily repeal the law's employer mandate. The bill sponsored by GOP Reps. Devin Nunes (Calif.) and Mike Kelly (R-Pa.) would suspend penalties for the employer mandate for 2015 through 2019 and delay implementation of the tax on high-cost employer-sponsored health plans for another year, pushing it back to 2022. (Hellmann, 7/12)

Source: The Hill

The Associated Press: Oklahoma Medicaid Approved For Drug Pricing Experiment
The federal Centers for Medicare and Medicaid Services has approved Oklahoma's Medicaid program for a first-in-the-nation drug pricing experiment that supporters say could save taxpayer dollars and provide patients with the most effective medications for their ailments. Under the "value-based purchasing" program approved in late June, the state and a pharmaceutical company would agree to a set payment if its medication works as advertised, but only a fraction of that if the drug is not as effective as promised. (7/13)

Source: The Associated Press

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The James Group, LLC
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Phone: (901) 273-8600
Fax: (901) 273-8700
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The James Group, LLC 
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Atlanta, GA 30339
Phone: 770-709-7210
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