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Medicare May just Save Hundreds of thousands By way of Taking Cue from Mark Cuban’s On-line Pharmacy

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News Picture: Medicare Could Save Millions By Taking Cue from Mark Cuban's Online Pharmacy

TUESDAY, June 21, 2022 (HealthDay Information) – Medicare would possibly wish to take into accout of the pricing technique of a brand new on-line pharmacy run through tech entrepreneur and “Shark Tank” pass judgement on Mark Cuban if it desires to save lots of billions on pharmaceuticals, a brand new learn about suggests.

Cuban’s Value Plus Drug gives sure generic medicine at inexpensive costs through promoting them at a markup of 15% plus a $3 flat price. Sufferers pay for the medicines, which come with the blood power drug Lisinopril and the antidepressant Prozac (fluoxetine), out of pocket as a result of Value Plus does not settle for insurance coverage. It additionally does not promote brand-name medicine.

The brand new learn about discovered that if Medicare was once paying the similar costs, it might have stored just about $4 billion in 2020.

“Medicare is overpaying for one of the generic medicine,” learn about creator Dr. Hussain Saleem Lalani, a researcher at Brigham and Ladies’s Sanatorium in Boston, advised NBC Information. “And it is a conservative estimate, so the true financial savings are most probably greater.”

Medicare “may just save much more cash if it had stricter insurance policies on the way it paid for medicine,” Lalani mentioned. “There may be much more reforms which may be carried out to optimize the generic drug pricing device, and we will have to actually believe doing the ones issues to decrease prices for sufferers.”

The analysis workforce seemed on the costs of 89 generic medicine bought through Value Plus Drug in 2022, evaluating them to the costs for those self same medicine paid through Medicare Phase D plans in 2020. Then, they adjusted for adjustments in drug prices between the 2 years.

The learn about discovered that Medicare paid greater than Value Plus for 77 generic medicine. The overall greenbacks spent was once $8.1 billion in comparison to the $4.5 billion that it will have value. It isn’t transparent if out-of-pocket prices would had been decrease for enrollees within the Medicare plan if the medication had been inexpensive.

Juliette Cubanski, deputy director of this system on Medicare coverage on the Kaiser Circle of relatives Basis, advised NBC Information that the learn about raised the query about whether or not Medicare plans are leaving cash at the desk.

At the moment, worth negotiation is “simply a fully black field. There may be now not a large number of transparency,” Cubanski added.

“We are roughly striking the weight at the sufferers to chase down decrease prescription drug costs versus roughly discovering tactics to cause them to broadly obtainable,” she mentioned.

Cubanski did be aware that the kinds of medicines sufferers most often have hassle paying for are brand-name medicine, now not generic ones. Democrats have known as for regulations that might permit Medicare to barter without delay to decrease the costs of the costliest medicine.

“Saving $3.6 billion is indubitably value pursuing if there may be a possibility to get that quantity of financial savings,” Cubanski mentioned. However many of the greenbacks from Medicare “are going to higher-priced, model call and uniqueness medicine.”

The learn about’s barriers come with that researchers may just most effective examine pricing at the medicine lined through Cuban’s corporate, which account for most effective about 25% of the medication incorporated in Medicare Phase D’s $38 billion in spending in 2020.

Lalani known as for a better have a look at the prescription drug pricing device, which incorporates wholesalers, pharmacy receive advantages managers, pharmacies and insurers.

The findings had been printed Monday within the magazine Annals of Inside Drugs.

Additional info

Kaiser Circle of relatives Basis has extra on public opinion on pharmaceuticals and their costs.

SOURCE: NBC Information

By way of Cara Murez and Robin Foster HealthDay Journalists


Copyright © 2021 HealthDay. All rights reserved.


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Medicare Merit Plans Incessantly Deny Protection for Eligible, Vital Care: File

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News Picture: Medicare Advantage Plans Often Deny Coverage for Eligible, Necessary Care: Report

THURSDAY, April 28, 2022 (HealthDay Information)

Protection for eligible, important care is denied each and every yr to tens of hundreds of seniors with personal Medicare Merit plans, U.S. federal investigators say.

In a record launched Thursday, the crew from the inspector common’s place of work of the U.S. Division of Well being and Human Services and products mentioned Medicare must fortify oversight of those plans and improve enforcement towards the ones personal insurance coverage firms with a trend of unsuitable denials of protection.

About 28 million older other people have Medicare Merit plans, which give privatized variations of Medicare which can be incessantly less expensive and supply a better vary of advantages than the standard executive program.

However the HHS findings problem claims via the business’s primary business workforce that Medicare Merit “delivers higher products and services, higher get right of entry to to care and higher worth.”

As an alternative, the investigators mentioned they discovered “fashionable and chronic issues associated with beside the point denials of products and services and cost.”

Their assessment of 430 denials via Medicare Merit plans in June 2019 printed that 13% of instances the place care used to be denied for clinical products and services have been in reality medically important and will have to were coated. In response to that fee, the investigators estimated as many as 85,000 requests for prior authorization of hospital therapy have been probably improperly denied in 2019.

The record additionally mentioned that Merit plans refused to pay about 18% of authentic claims, about 1.5 million bills, in 2019. In some instances, plans left out prior authorizations or different documentation to beef up the cost.

Essentially the most widespread denials incorporated the ones for MRIs and CT scans. In a single case, an Merit plan refused to approve a follow-up MRI to decide whether or not a lesion used to be malignant after it used to be known thru an previous CT scan for the reason that lesion used to be too small. The plan reversed its choice after an attraction, the New York Instances reported.

In every other case, a affected person needed to wait 5 weeks sooner than authorization to get a CT scan to evaluate her endometrial most cancers and decide a process remedy. Such behind schedule care can threaten a affected person’s well being, the record famous.

However Merit plans additionally denied requests to ship sufferers improving from a health center keep to a talented nursing facility or rehabilitation heart when medical doctors decided the ones puts have been extra suitable than sending a affected person house, the Instances mentioned.

As an example, a affected person with bedsores and a bacterial pores and skin an infection used to be denied a switch to a talented nursing heart, investigators discovered, whilst a high-risk affected person improving from surgical operation to fix a fractured femur used to be denied admission to a rehab heart.

Obviously, those denials might lengthen or save you a Medicare Merit beneficiary from receiving wanted care, in line with record crew chief Rosemary Bartholomew. Few sufferers or suppliers attempt to attraction those choices, she famous.

“We are additionally involved that beneficiaries might not be acutely aware of the better obstacles,” Bartholomew instructed the Times.

A 2018 record via the HHS inspector common’s place of work discovered that personal plans reversed about three-quarters in their denials on attraction.

Hospitals and medical doctors have lengthy sounded off about insurance coverage corporate techniques, and law to take on a few of the ones considerations is being thought to be via Congress, in line with the Instances.

The record’s findings are being reviewed to decide suitable motion, and plans with repeated violations will face expanding consequences, Medicare officers mentioned in a commentary, the Instances reported.

They mentioned the company “is dedicated to making sure that individuals with Medicare Merit have well timed get right of entry to to medically important care.”

Additional info has extra on Medicare Merit plans.

SOURCE: New York Instances

By means of Robert Preidt HealthDay Reporter


Copyright © 2021 HealthDay. All rights reserved.


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1 in 5 Medicare Sufferers Use Scientific Marijuana: Survey

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News Picture: 1 in 5 Medicare Patients Use Medical Marijuana: Survey

THURSDAY, April 14, 2022 (HealthDay Information)

One in 5 Medicare recipients use scientific marijuana and two-thirds say it will have to be lined by way of Medicare, a brand new survey unearths.

Scientific marijuana is criminal in 37 states, 4 territories and the District of Columbia, however it is not lined by way of Medicare, the federal medical insurance program for older American citizens. Ownership of marijuana stays unlawful beneath federal regulation.

The ballot of one,250 Medicare recipients used to be carried out in April and located that one in 5 use scientific marijuana and 23% have used it up to now. In all, 21% mentioned they use it to regard a number of scientific prerequisites.

Present use for well being causes used to be best amongst respondents who extensively utilized marijuana recreationally (39%). In all, 28% of leisure customers mentioned they in the past used scientific marijuana.

Respondents use it to regard quite a few bodily and psychological well being prerequisites, together with 32% for anxiousness and 31% for continual ache. More or less one-quarter mentioned they use it to regard melancholy, glaucoma, and signs related to HIV/AIDS, together with nausea, urge for food loss and ache.

Amongst respondents, fortify used to be robust for Medicare protection of scientific marijuana.

Two-thirds mentioned they “strongly agree” or “agree” that scientific marijuana will have to be lined. Thirty-four % mentioned they “disagree” or “strongly disagree.”

Just about six in 10 supporters of Medicare protection mentioned they accomplish that as a result of scientific marijuana may also be efficient when different therapies fail.

Unusually, fortify for Medicare protection used to be decrease amongst present scientific marijuana customers (56%), in comparison with 63% of earlier customers and 71% of those that mentioned they have by no means used it.

Why the reluctance amongst present customers?

Just about 4 in 10 (38%) mentioned they concern Medicare protection would build up the drug worth.

Pollsters discovered that present customers’ out-of-pocket prices have been wide-ranging. Part reported spending as much as $200 per thirty days; 36%, between $201 and $500 per thirty days; and 14% greater than $500 a month.

In all, 31% of customers who oppose Medicare protection of scientific marijuana cited unknown long-term affects and a loss of analysis into its makes use of and effectiveness.

Part of customers mentioned they would really like scientific marijuana to be lined by way of Medicare as a result of it is a multipurpose remedy.

Amongst earlier customers who fortify Medicare protection, the highest explanation why (48%) is that marijuana is a herbal treatment, no longer an artificial pharmaceutical.

The survey additionally discovered variations in line with political views, with 71% of Democrats; 65% of Republicans; and 63% of independents, third-party participants, and apolitical seniors announcing they “agree” or “strongly agree” that Medicare will have to quilt scientific marijuana.

The web ballot used to be commissioned by way of, a bunch that examines Medicare problems.

Additional info

There may be extra on marijuana the U.S. Nationwide Institute on Drug Abuse.

SOURCE:, information unencumber, April 12, 2022

By means of Robert Preidt HealthDay Reporter


Copyright © 2021 HealthDay. All rights reserved.


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Medicare Will Handiest Quilt Aduhelm for Alzheimer’s Sufferers in Medical Trials

News Picture: Medicare Will Only Cover Aduhelm for Alzheimer's Patients in Clinical TrialsThrough Cara Murez and Robin Foster HealthDay Journalists

FRIDAY, April 8, 2022 (HealthDay Information) – Medicare introduced Thursday that it is going to prohibit its protection of the expensive new drug Aduhelm to Alzheimer’s sufferers enrolled in scientific trials of the drug.

Licensed amid controversy closing 12 months by means of the U.S. Meals and Drug Management, the most recent resolution was once intended to give protection to sufferers whilst accumulating extra scientific information on whether or not the drugs in reality is helping sluggish declines in considering, consistent with officers with the U.S. Facilities for Medicare and Medicaid Products and services (CMS).

“There may be the opportunity of promise with this remedy; then again, there isn’t recently sufficient proof demonstrating stepped forward well being results to mention that it’s cheap and vital for other folks with Medicare, which is a key attention for CMS when making nationwide protection determinations,” mentioned Dr. Lee Fleisher, CMS leader scientific officer and director of the Heart for Medical Requirements and High quality. “In arriving at this ultimate resolution, we regarded on the very distinctive cases round this elegance of therapies and decided that weighed the opportunity of affected person receive advantages in opposition to the importance of great unknown elements that would result in hurt.”

Whilst making an allowance for its ultimate resolution, the CMS gained 10,000 feedback on its web site, a mixture of emotional pleas from sufferers, households and teams representing Alzheimer’s sufferers, in addition to medical doctors and mavens who suggested warning for the reason that drug has critical attainable protection dangers and its effectiveness remains to be unsure.

CMS Administrator Chiquita Brooks-LaSure informed the New York Instances that “the overwhelming majority” of feedback have been for “in point of fact restricting protection of Aduhelm to a in point of fact managed house the place shall we proceed to judge its appropriateness for the Medicare inhabitants.”

Aduhelm gained speeded up approval closing summer season, which permits authorization of substances through which advantages are unsure however there are few possible choices for the stipulations they will lend a hand.

Some of the considerations about Aduhelm are that whilst in a single scientific trial sufferers confirmed a slight slowing of considering declines, a virtually an identical trial confirmed no receive advantages in any respect. Negative effects have been critical for roughly 40% of sufferers, who skilled mind swelling or mind bleeding that ranged from gentle to critical.

Previous to the drug’s approval, the FDA’s unbiased advisory committee had mentioned there wasn’t sufficient proof for approval and voiced considerations that the company had labored too intently with producer Biogen all the way through the approval procedure. 3 committee contributors resigned in protest over the verdict.

Going ahead, Medicare will quilt the drug for any individual in any trial authorised by means of the FDA and the U.S. Nationwide Institutes of Well being. Biogen should additionally whole every other scientific trial, however that effort may take years.

Advocacy teams had campaigned for broader protection of the drug, pronouncing limiting it was once discriminatory as a result of no longer all Alzheimer’s sufferers have get admission to to scientific trials.

“The Alzheimer’s Affiliation is deeply upset that the Facilities for Medicare & Medicaid Products and services has necessarily not noted the wishes of other folks residing with Alzheimer’s illness,” Harry Johns, CEO of the group, mentioned in a commentary launched Thursday. “CMS has created needless limitations for people with Alzheimer’s illness. Sufferers with Alzheimer’s, a deadly illness, must have FDA-approved therapies lined by means of Medicare simply as the ones dealing with different illnesses do.”

“Significantly, CMS has mentioned in its resolution the one manner for sufferers to get admission to the primary authorised FDA remedy focused on amyloid in the ones residing with Alzheimer’s is to sign up for a scientific trial,” Johns added. “Whilst we word CMS has expanded the place the ones scientific trials might happen, in fact this stays an needless and not earlier than imposed barrier to get admission to an FDA-approved remedy.”

A lingering query is whether or not will increase to the Medicare Phase B premiums might be revised to mirror that Medicare is probably not overlaying this pricey drug for most of the people.

The company “is taking a look at that, and remains to be going during the procedure,” spokeswoman Beth Lynk informed the Related Press.

The projected value of Aduhelm was once a big driving force at the back of a $22 build up in Medicare’s Phase B top rate this 12 months, boosting it to $170.10 a month. When authorised, Aduhelm had an annual price ticket of $56,000, however the corporate diminished that to $28,000 a 12 months following susceptible gross sales of the drug after many scientific establishments mentioned they wouldn’t suggest the

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Medicare Now Covers COVID Exams Purchased at Drug Shops

News Picture: Medicare Now Covers COVID Tests Bought at Drug Stores

TUESDAY, April 5, 2022 (HealthDay Information) – Medicare introduced Monday that seniors can now stroll into maximum drug retail outlets and get a loose over the counter COVID take a look at.

“For the primary time in its historical past, Medicare is paying for an over the counter take a look at,” Deputy Administrator Dr. Meena Seshamani, director of the Heart for Medicare, mentioned in a information liberate at the announcement. “It’s because COVID-19 checking out is a essential a part of our pandemic reaction. Blended with the loose over the counter exams to be had thru, this initiative will considerably build up checking out get right of entry to for American citizens maximum at risk of COVID-19.”

Now the 59 million American citizens coated via Medicare Phase B can stand up to 8 loose, at-home exams each and every month from any supplier that gives them, the Facilities for Medicare and Medicaid Services and products mentioned within the information liberate.

“That is all a part of our general solution to ramp up get right of entry to to easy-to-use, at-home exams without cost,” Well being and Human Services and products Secretary Xavier Becerra mentioned within the CMS information liberate. “Since we took administrative center, we have now greater than tripled the choice of websites the place other folks can get COVID-19 exams free of charge, and we are additionally handing over with reference to 250 million at-home, fast exams to ship free of charge to American citizens who want them….With as of late’s step, we’re additional increasing medical insurance protection of loose over the counter exams to Medicare beneficiaries, together with our country’s aged and other folks with disabilities.”

Collaborating suppliers in this system come with Albertsons Firms Inc., Costco Pharmacy, CVS, Meals Lion, Massive Meals, The Massive Corporate, Hannaford Pharmacies, H-E-B Pharmacy, Hy-Vee Pharmacy, Kroger Circle of relatives of Pharmacies, Ceremony Help Corp., Store & Forestall, Walgreens and Walmart, the company mentioned.

Greater than 64 million older folks and other folks with disabilities are insured via Medicare. The loose, over the counter take a look at program will proceed till all through the COVID-19 public well being emergency.

How lengthy the general public well being emergency will proceed is dependent upon what COVID variants do someday.

At this time, all eyes are at the “stealth” BA.2 Omicron subvariant, which accounts for simply over 72 % of U.S. COVID circumstances, CDC information presentations. The unique Omicron variant prompted a surge that was once the biggest spike but in virus circumstances, however the ones numbers have dropped to the bottom ranges noticed since closing summer time’s Delta variant unfold all through the rustic.

Many Medicare beneficiaries also are now additionally eligible for a 2d booster shot, which the FDA authorized closing week for other folks age 50 and older and the ones with weakened immune methods.

Additional info

The U.S. Covid site has extra on COVID-19.

SOURCE: CBS Information

By means of Cara Murez and Robin Foster HealthDay Journalists


Copyright © 2021 HealthDay. All rights reserved.

General Article

Medicare to Supply Unfastened COVID-19 Speedy Exams

News Picture: Medicare to Provide Free COVID-19 Rapid Tests

FRIDAY, Jan. 4, 2022 (HealthDay Information)

Medicare will quickly supply as much as 8 loose COVID speedy exams a month to seniors enrolled within the govt medical health insurance program, the Biden management introduced Thursday.

The brand new coverage for the over the counter exams will take impact in early spring. The at-home exams might be to be had at pharmacies and different places for purchasers with Medicare’s “Section B” outpatient get advantages, which about 90% of enrollees have.

This would be the first time that Medicare has lined an over the counter check without charge to recipients, the Related Press reported.

Get right of entry to to loose COVID speedy exams may also be to be had to other people with Medicare Benefit, a non-public insurance coverage possibility utilized by 4 in 10 Medicare enrollees. The ones plans can already quilt over the counter COVID-19 exams as a supplemental get advantages, the AP reported.

Medicare will proceed to offer loose lab-based PCR checking out, however the ones exams must be ordered through a clinician or a licensed well being care skilled, White Area officers stated.

Final month, the Biden management advised non-public insurers to offer as much as 8 loose at-home exams a month for his or her purchasers.

Thursday’s announcement that Medicare will do the similar used to be applauded through the AARP, an advocacy crew for older other people.

“AARP applauds lately’s announcement that can ensure get admission to to at-home over the counter COVID-19 exams without charge for Medicare’s 64 million beneficiaries… Expanded get admission to to no-cost checking out will lend a hand give protection to seniors who’ve been hit toughest through the pandemic and make sure they are able to stay attached with their family members and group,” Nancy LeaMond, an AARP government vice chairman and its leader advocacy and engagement officer, stated in a observation.

“Each and every American will have to have a very easy option to get at-home COVID exams. We all know that individuals 65 and older are at a lot higher chance of significant sickness and demise from this illness — they want equivalent get admission to to equipment that may lend a hand stay them protected,” she added. “The price of paying for exams and the time had to to find loose checking out choices are obstacles that might discourage Medicare beneficiaries from getting examined, main to bigger social isolation and endured unfold of the virus.”

Earlier than Thursday’s announcement, Medicare enrollees may get loose at-home exams through inquiring for 4 loose exams for domestic supply via or choosing up loose exams up from group places comparable to libraries or senior facilities that distribute them. The ones choices will stay to be had whilst the brand new coverage goes into impact, the AP reported.

Additional information

Seek advice from the U.S. Facilities for Illness Regulate and Prevention for extra on COVID exams.

SOURCE: Related Press

Robert Preidt and Robin Foster


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