Policy & Regulations

This channel includes news coverage of healthcare policy and regulations set by Congress, the states, Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), U.S. Food and Drug Administration (FDA), and medical associations and societies.

FTC sues PBMs and GPOs for insulin price collusion
In a statement announcing its lawsuit, the FTC said Caremark, Optum RX and Express Scripts benefit from manufacturer rebates and ignore lower-costing drugs as a way to artificially increase prices.
FTC sues drug middlemen over insulin prices, puts others on notice
The FTC alleges that pharmacy benefit managers have set up a system where they get rich, while patients are forced to pay rising insulin costs. The agency also called out drug manufacturers such as Eli Lilly, Sanofi and Novo Nordisk, saying their own actions have raised serious concerns.
Study ranks US health system dead last among wealthy nations
Low rankings for accessibility and outcomes earned the country the overall lowest ranking in an analysis of healthcare systems across 10 nations.
Landmark opioid trial in Baltimore set to begin; Johnson & Johnson settles to avoid jury
Six companies have settled with the city for as total of over $402M. Two remaining defendants, McKesson and AmerisourceBergen, will test their luck in court.
Coalition of 86 healthcare groups calls for change to Affordable Care Act rule
In a letter to Congress, the groups are urging lawmakers to support HR 9001 and lift the ban on physician-run hospitals.

Initial ACA exchange signups set new record

The first few days of open enrollment on the Affordable Care Act (ACA) exchanges saw a record number of people signing up for coverage, according to The Hill.

November 7, 2017

More clinicians will be exempt from MIPS in 2018, won’t be able to opt in

CMS has finalized the rule for the second year of Medicare Access and CHIP Reauthorization Act’s (MACRA) Quality Payment Program (QPP), raising the low-volume threshold for the Merit-based Incentive Payment System (MIPS) but not allowing clinicians the option to participate if they don’t meet the minimum requirements.

November 3, 2017

5 things about the final OPPS rule and hospitals’ lawsuit over 340B change

CMS released its final hospital outpatient prospective payment system (OPPS) rule for 2018, which included a significant cut to drug payments to hospitals which use the 340B drug discount program. The result was the quick threat of a lawsuit from three major medical groups.

November 2, 2017

10 things Democrats want from the next HHS Secretary

The top Democrats on the Senate’s finance and health committees have outlined 51 criteria for judging President Donald Trump’s next nominee to run HHS, with many of their priorities going against the policies touted by Trump and former HHS Secretary Tom Price, MD.

November 2, 2017

ACA 'sabotage’ more difficult to fight than repeal

While supporters of the Affordable Care Act (ACA) were able to keep the law from being repealed and replaced in 2017, helping people sign up for coverage while the Trump administration has made deep cuts to enrollment efforts will be more difficult.

November 1, 2017

Trump’s opioid panel could change patient surveys, prescriber training

The commission on combating opioid addiction and abuse set up by President Donald Trump will issue its final recommendations on Nov. 1, with a draft copy laying out policies that could affect everything from patient surveys to reimbursement for addiction treatment.

October 31, 2017

CMS proposes letting states change ACA’s essential health benefits, medical loss ratio

The definition of “essential health benefits” which Affordable Care Act-compliant health plans have to cover would be up for states to decide under a rule proposed by CMS, echoing similar provisions which had been included in Republican legislative efforts to repeal and replace the ACA.

October 27, 2017

6 states could be out of CHIP funds by January

Federal funding for the Children’s Health Insurance Program (CHIP) expired at the end of September, and with no quick renewal expected from Congress, states are on their own to keep the program afloat. According to a report from the Georgetown University Center for Children and Families, six states won’t be able to do so past early January.

October 27, 2017

Around the web

Cardiovascular Business

FTC sues drug middlemen over insulin prices, puts others on notice

The FTC alleges that pharmacy benefit managers have set up a system where they get rich, while patients are forced to pay rising insulin costs. The agency also called out drug manufacturers such as Eli Lilly, Sanofi and Novo Nordisk, saying their own actions have raised serious concerns.

Cardiovascular Business

Cath lab techs and nurses see new normal with post-COVID pay

In the post-COVID era, wages for permanent RNs are rising, and wages for travelers are decreasing. A new report tracked these trends and more.

Cardiovascular Business

Merit Medical to purchase Cook Medical’s lead management portfolio for $210M

Two medical device companies have announced a transaction that could shake up the U.S. electrophysiology market.