Good morning ... Congrats to Villanova. And now, back to barely caring about sports until November.
People who get their coverage through the Affordable Care Act are generally pretty happy with it, but they think it's falling apart fast. That's the takeaway from the Kaiser Family Foundation’s latest polling.
By the numbers: Among people who get their coverage through the law’s insurance exchanges ...
Majorities of the overall public, independents, Republicans and ACA enrollees said the exchanges are "collapsing." So did a plurality of Democrats.
Between the lines: The overwhelming majority of ACA enrollees get a subsidy to help cover the cost of their premiums. That’s why so many people thought their premiums hadn't changed, even in a year that actually saw substantial premium hikes across the country.
Yesterday, we brought you a 5-part investigation into the contracting practices of pharmacy benefit managers, based in part on contract documents from Express Scripts, the country’s largest PBM.
Express Scripts declined multiple requests to comment on that reporting, but the industry’s trade organization, the Pharmaceutical Care Management Association, reached out after it ran with a few thoughts/complaints.
1 big thing: “The single biggest factor which determines how much [a] drug costs,” PCMA president and CEO Mark Merritt wrote, is “the prices drug companies set.”
Reality check: As much as PBMs and pharmaceutical companies see this as a zero-sum battle between their two industries, they both deserve some scrutiny here.
The merger talks between Walmart and Humana have barely gathered oxygen, yet Walmart already appears to have another health care target in mind: PillPack, a mail-order pharmacy startup. CNBC first reported the news, and Axios’ Dan Primack confirmed that talks were occurring — although a deal is not imminent.
The bottom line, per Axios' Bob Herman: If Walmart takes over Humana and PillPack (both still huge ifs), Walmart will become a gigantic health care player overnight offering digital and physical pharmacies, home health services and health insurance all under one roof.
The conventional wisdom is that comparatively few doctors want to accept Medicaid because it pays so much less than Medicare or private insurance. Medicaid is also a bigger administrative hassle, according to new research published in Health Affairs.
The numbers: Roughly 18% of claims in traditional fee-for-service Medicaid are challenged, compared with just 6% in private insurance. A far higher number are ultimately rejected, too.
Why it matters: The study’s authors estimate that administrative expenses make up roughly 30% of U.S. health care spending — part of the reason we spend so much more than other countries.
Why it matters: Delaying the regulation would be another pharma-friendly move by the Trump administration. Horizon Pharma, for example, recently told investors the rule would cut revenue of its drug Krystexxa by 25% in 2018, per Height Capital Markets.
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