With the GOP in control of Congress and the White House, hospitals could face budget cuts and tighter oversight, after a period of benefiting from generous federal spending under President Biden. Much of it comes down to hospitals' reliance on government insurance programs like ACA exchanges and Medicaid that could be cut down to size by Republicans looking for ways to trim government spending and pay for tax cuts. Medicaid expansions, boosted subsidies for ACA plans and programs like state directed payments—which funnel Medicaid dollars to hospitals—poured billions into the system, benefiting insurers and providers serving these programs. States and the federal government typically pay insurers, who then pay providers like hospitals. In recent years, due to changes in regulations, states have been able to tap additional federal dollars to steer more payments directly to providers. Just in October, analysts at TD Cowen upgraded hospital stocks, citing an expansion of state directed payments in several states.
Medicare is paying wildly different prices for the same drug, even for people insured under the same plan. As a result, people covered by Medicare can be on the hook for thousands of dollars in additional out-of-pocket costs depending on where they live and which drug plan they choose. Take commonly used generic versions of prostate-cancer treatment Zytiga. They have more than 2,200 prices in Medicare drug plans. The generics ring in at roughly $815 a month in northern Michigan, about half of what they cost in suburban Detroit, while jumping to $3,356 in a county along Lake Michigan, according to a recent analysis of Medicare data.
The Biden administration plans to require Medicare and Medicaid to offer coverage of weight loss medications for patients seeking to treat obesity. The new rule, which was proposed by the administration on Tuesday, would dramatically expand access to anti-obesity medications like Wegovy, Ozempic and Mounjaro. Until now, Medicare and Medicaid have only provided insurance coverage for these drugs when they are used to treat conditions such as diabetes.
Robert F. Kennedy Jr. and his advisers are considering an overhaul of Medicare's decades-old payment formula, a bid to shift the health system's incentives toward primary care and prevention, say four people who spoke on the condition of anonymity to discuss private deliberations. The discussions are in their early stages, the people say, and have involved a plan to review the thousands of billing codes that determine how much physicians get paid for performing procedures and services.
Mehmet Oz, MD, has sown misinformation about COVID treatments, weight loss hacks and unproven supplements. He has invested in drug companies, even as he has publicly taken aim at Big Pharma, and has profited from a medical device that he helped invent but that has been subject to several recalls. Over roughly two decades in the public eye, Oz has drawn the ire of medical experts, members of Congress and even his own peers, including a group of 10 doctors who called for him to be fired from a faculty position at Columbia University, arguing he had shown a “disdain for science." The university quietly cut its public ties with Oz in 2022.
CVS Health, UnitedHealth Group and Cigna are suing the FTC, claiming that the agency's case against drug supply chain middlemen over high insulin prices in the U.S. is unconstitutional. The complaint is the latest move in a bitter legal fight between the three largest PBMs in the U.S. and the FTC. The FTC in September sued CVS's Caremark, Cigna's Express Scripts and UnitedHealth's Optum Rx in the agency's administrative court, accusing those PBMs and other drug middlemen of using a "perverse" rebate system to boost their profits while inflating insulin costs for Americans.