Rhode Island insurers release ACA rate increases
Blue Cross Blue Shield of Rhode Island requested a 10.7% average increase to ACA exchange premiums for next year.
A second insurer, Neighborhood Health Plan of Rhode Island, asked for a more modest 8.7% increase.
Filed with the Office of Health Insurance Commissioner, the insurers blamed the rate increases on prescription drug costs along with “uncertainty over federal policy actions around the Affordable Care Act.” The insurers added that a halt to cost-sharing subsidies, plus the individual mandate repeal, drove the premiums.
While BCBSRI’s request was lower than last year’s request of 13.9%, NHPRI saw a notable jump from the 5% increase requested last year. (Release)
OIG brings in $1.46B in fraud recoveries
The Office of Inspector General brought in $1.46 billion in expected investigative recoveries tied to fraud between Oct. 1, 2017 and March 31, 2018.
Over that six-month span, the agency brought criminal actions against 424 individuals or entities and excluded 1,588 people from federal programs.
Inspector General Daniel Levinson said the OIG is investigating “a growing workload of opioid-related fraud cases,” noting that data continues to play a key role in the enforcement agency’s efforts. (Report)
Pharmacy owners pay $3.2M in false claims case
The owners of a Philadelphia pharmacy have agreed to pay $3.2 million to resolve allegations that they billed Medicare for prescriptions that were never dispensed.
Federal prosecutors alleged the pair submitted false claims over a six-year period that included inhalers, heart medications, asthma and cholesterol prescriptions. (Release)
Duke professors say PBM-insurer mergers won’t benefit consumers
Optimists might say recent moves by insurers to acquire pharmacy benefit managers will help control costs.
But two Duke professors think otherwise, writing in an op-ed for STAT News that the PBM “might be the tail that wags the dog.” The pair argued that patients could be directed towards drug treatments that generate the highest profit margins, including specialty medications and cancer drugs.
“Under this nightmarish scenario, pharmacy benefit managers would be far worse than costly middlemen,” they wrote. “They would control health care and pharmaceutical innovation, and direct patients toward high profit margins rather towards high-value care.”
Cigna is looking to close a deal with Express Scripts, while CVS is in the process of acquiring Aetna. (STAT)