Payer Roundup—CMS reviews Alabama work requirements; Drug prices are still climbing

Medicaid on paper and a stethoscope
CMS will review Alabama's Medicaid work requirement waiver. (Getty/designer491)

CMS to review Medicaid work requirements

The Trump administration will review an application from Alabama to implement work requirements in the Medicaid program.

The state's proposal would require residents with Medicaid coverage to work, attend job training or do community service 35 hours a week, while parents of children younger than six would be required to work 20 hours, according to The Hill. The state argues that working parents will improve the health of young children.

The plan includes certain exemptions for pregnant women and residents over 60 years of age. Department of Health and Human Services Secretary Alex Azar has said his agency is “undeterred” by a recent ruling striking down the approval of Kentucky’s work requirements. (The Hill)


2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

UnitedHealth warns hospitals it could drop Envision

UnitedHealth sent a notice to 300 hospitals, warning them that the insurer plans to drop the emergency staffing firm Envision from its network beginning next year, according to Axios.

In April, court filings indicated that UnitedHealth planned to cut ties with the staffing company next year, and negotiations have gone nowhere since then. Investment firm KKR bought Envision for $10 billion in June.

Dan Rosenthal, president of UnitedHealthcare's provider networks, warned hospitals that they could “experience a decrease in patient satisfaction driven from higher out-of-pocket costs and patient confusion.” (Axios)

Humana survey: One-third of seniors aren’t socially engaged

Nearly one-third of seniors 65 and older don’t feel they are socially engaged despite recognizing the importance of friendships and companionship, a new survey from Humana shows.

One place that could solve that issue: the gym. Nearly one-quarter of respondents said they go to the gym on a regular basis, and 54% of single seniors expressed interest in meeting someone there. (Survey)

Brand name drug prices are still going up

Trump may have promised that drug manufacturers would voluntarily reduce prices, but it’s not happening, according to the Associated Press.

An AP investigation of drug prices for the first seven months of the year found 96 price hikes for every price cut. Although there were fewer price increases than in previous years, all told there were just 46 price cuts.

HHS Secretary Alex Azar said admitted the administration’s drug pricing policy would take some time.

“I am not counting on the altruism of pharma companies lowering their prices,” he told the AP. (AP article)

Surprise billing could be a campaign issue

Although concerns around surprise billing are generating more media attention and prompting some legislators to draft legislation, the topic hasn’t emerged as a campaign issue.

But polling shows that the issue could generate a lot of public traction, writes Kaiser Family Foundation President and CEO Drew Altman in Axios. But it’s also an issue that’s difficult to pin blame for on either party, which makes it a weak attack issue.

“People talk about their unexpected bills a lot, and with a sense of outrage. It’s the candidates who aren’t talking about it on the campaign trail, and that’s almost certainly a missed opportunity,” Altman writes. (Axios)

Suggested Articles

Health insurers’ financial performance is on a continuing upward trend, but political and legal risks could pose a threat to that growth.

Senate lawmakers released a draft package of legislation Thursday aimed at curbing health care costs they said they believe they can pass on a bipartisan basis…

Attorneys general seeking to defend the ACA argue that their opponents—including the DOJ—have poor legal standing to challenge the law.