Good morning ... If this isn't the perfect visual representation of life in the year 2018, I don't know what is.
Pharmacy benefit managers took a beating yesterday on Wall Street as the world remembered/realized they are the prime target of the Trump administration's plan to curb prescription drug prices, and that plan is moving forward.
Threat level: We know enough about the Trump administration's next big health care regulation to know what's at stake, even if a lot of the specific details still need to be filled in.
What they're saying: The existing structure “is the soft-underbelly of the PBM alligator. This proposal seemingly guts it. If not replaced with some other scheme, their current business model evaporates and they become what they were—low-margin claims processors," drug industry lobbyist Barrett Thornhill told the Wall Street Journal.
The administration is still talking tough with pharma, while nevertheless positioning itself on the same side of the issue substantively.
Yes, but: As the New York Times notes, Merck's price cuts aren't as impressive if you look closer at which products they cover.
The bottom line: The administration has always been more focused on PBMs than pharmaceutical companies when it comes to drug prices, and there's no reason to think that has changed.
About 4 million more people would have insurance and premiums would be roughly 12% lower if every state passed its own version of the Affordable Care Act’s individual mandate, according to new research from the Commonwealth Fund and the Urban Institute, both liberal think tanks.
It seems extremely unlikely that any of those states would pass individual mandates.
Where it stands: New Jersey is the only state to pass its own mandate since Congress nullified the ACA’s. Massachusetts already had one. That leaves 48 more states — and passing an insurance mandate at the state level is still pretty hard. It's still an unpopular policy, at least nationally.
The catch: So far, the loss of the federal mandate has not been as devastating as many experts predicted.
The number of low-income people and children who are enrolled in a Medicaid plan managed by a private health insurer, as of June 30: 54 million, according to new estimates from consulting group Health Management Associates.
Why it matters: That means three-quarters of all Medicaid enrollees are now in private plans vs. general government enrollment. But some research suggests going from a standard program to privatized Medicaid may not save states money.
What to watch: North Carolina wants to move to Medicaid managed care by 2019, and a request for proposal is expected to come out next month, Axios' Bob Herman notes. This will be a multi-billion-dollar opportunity for insurers.
Well here’s a downer, courtesy of the New England Journal of Medicine: Bundled payments — a precursor to the broader shift toward “value-based” care — may not work.
How it works: The big animating idea for the health care delivery system is to stop paying each individual nurse, doctor, hospital and clinic for each individual service they perform, and instead start paying for a single episode of care — for treating Patient X for Condition Y.
The details: Researchers looked at the results for the five conditions most commonly reimbursed through Medicare's bundled payments initiative, comparing several metrics:
The bottom line: Accepting bundled payments “was not associated with significant changes” in any of those metrics, the researchers found.
Have a great weekend. Holler if you have any big ideas for what we should be watching next week: email@example.com.