The state of Texas is accusing major pharmacy benefit managers and drug companies of colluding to raise the cost of insulin. Texas alleged drug manufacturers Eli Lilly, Novo Nordisk and Sanofi raise the price of insulin and then pay an undisclosed amount back to PBMs Optum Rx, Express Scripts and CVS Caremark through a quid pro quo agreement. PBMs then give preferred status on its standard formularies to drugs with the highest list prices, the state said.
An Office of Inspector General (OIG) report found that the VA and Oracle Health did not have adequate controls to prevent system changes in the EHR project from causing major incidents, to respond to those incidents uniformly and thoroughly, or to mitigate their impact by providing standard procedures and interoperable downtime equipment. The EHR system experienced hundreds of major performance incidents affecting the five VA medical centers where the system was initially deployed.
The Biden administration could stand to take a firmer hand on hospital price transparency, especially when it is unclear whether the price data being published are even accurate, the Government Accountability Office (GAO) wrote in a Wednesday report. The Centers for Medicare & Medicaid Services (CMS) has required hospitals to post the prices for numerous services annually and this past summer raised the bar by ensuring hospitals were doing so using a standardized file format.
The US health care system remains the most expensive in the world, largely funded by the federal government, state Medicaid programs, and employers. In just a decade, national health spending rose from $2.8 trillion in 2012 to $4.5 trillion in 2022, even though demand and utilization remained relatively steady. According to projections published in Trilliant Health’s 2024 Trends Shaping the Health Economy report, health care spending could reach $7.7 trillion by 2032.
The Department of Health and Human Services’ Office of the Inspector General clarified that it wants remote physiologic monitoring to continue, despite its report that prods Medicare to develop more oversight for billing. But according to five experts, OIG’s claims in the September RPM oversight report are confusing, inaccurate and could jeopardize the future of the service. The Alliance for Connected Care sent a letter to OIG on Wednesday that asks it to retract and re-publish the report due to its “inaccuracies and subjective nature.”
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