News for Insurers
Top stories summarized by our editors
2/16/2018

FDA Commissioner Scott Gottlieb said a national e-prescribing system is needed for controlled substances. Legislation -- the Every Prescription Conveyed Securely Act -- introduced by Rep. Katherine Clark, D-Mass., could help reduce prescription drug abuse and improve efforts to reduce the risk of certain prescription drugs, Gottlieb said.

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Regulatory Focus
2/16/2018

HHS Secretary Alex Azar said that drugs currently covered by Medicare Part B could benefit from the negotiations carried out in Medicare Part D, adding that other proposed policies would give pharmacy benefit managers more leverage to "fight against the branded drug companies to keep those list prices down."

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HHS, Medicare, Alex Azar
2/16/2018

FDA Commissioner Scott Gottlieb said he will do everything within his authority to prevent drugmakers from "gaming the system" to thwart competition and said he wants to accelerate the generic- and biosimilar-drug approval processes.

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Kaiser Health News
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Commissioner Scott Gottlieb, FDA
2/16/2018

Critics of drugmakers' copayment coupons say the coupons artificially drive demand for expensive brand-name drugs and sustain high prices, which insurers must pay. Medicare and Medicaid ban the use of copay coupons entirely, California recently banned coupons for branded drugs with a generic alternative, and Massachusetts and New Jersey are considering similar restrictions.

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Health Affairs
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Medicare, Medicaid
2/16/2018

Guy Sheneman, a pharmacist from Weleetka, Okla., received a two-year prison term plus three years of supervised release and was ordered to pay a fine of $100,000 after being convicted of health care fraud. Sheneman overbilled Medicare and Medicaid from January 2012 to October 2014 by submitting fraudulent claims for more expensive drugs than those actually dispensed to patients, prosecutors said.

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Tulsa World (Okla.)
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Medicaid, Medicare, fraud
2/16/2018

Arkady Goldin, owner of Value Pharmacy in Lynbrook, N.Y., is facing health care fraud, grand larceny and other charges on allegations that he paid thousands of dollars in illegal kickbacks to a former hospital worker in exchange for referring expensive cancer medications, which allowed the pharmacy to submit at least $1.9 million worth of fraudulent claims to Medicaid. An asset forfeiture and civil recovery action seeking more than $8.7 million in penalties and damages also was filed against Goldin and the pharmacy by the Attorney General's Medicaid Fraud Control Unit, which claims the owners of the pharmacy made millions through the scheme.

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Patch
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Value Pharmacy, Arkady Goldin
2/16/2018

Felicia Ricks and Michael Robinson, both residents of Caruthersville, Mo., were charged with Medicaid fraud and conspiracy to commit Medicaid fraud, respectively, on allegations of working together to defraud the program. Authorities say Ricks lied about providing in-home personal care services to Robinson while the latter was in jail, resulting in over $6,000 worth of improper payments from Medicaid.

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Felicia Ricks, Michael Robinson
2/16/2018

Otho Schilling, a former church pastor from Mount Hermon, La., was charged with theft on allegations of fraudulently collecting Social Security funds. Authorities say Schilling failed to disclose his employment and income to the Social Security Administration, allowing him to receive over $200,000 in Retirement, Survivors and Disability Insurance benefits from the agency from 2005 to 2016.

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Otho Schilling
2/16/2018

HHS Secretary Alex Azar said the department would look carefully at Idaho's plan to allow the sale of insurance that doesn't comply with the Affordable Care Act to see how it measures up to the law, but told senators that he did not know the details of the state's plan as it had not requested a waiver. Critics say the state's plan is illegal and could lead to higher rates on people with pre-existing conditions.

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Alex Azar, HHS
2/15/2018

The CMS Office of the Actuary expects US health care spending to grow an average of 5.5% annually from 2017 to 2026, reaching $5.7 trillion, driven by rising prices for health care goods and services and the aging population. Prescription drug spending will see the fastest average growth at 6.3% annually as prices and use of specialty drugs increase, while the insured rate is predicted to decline to 89.3% from 2016's 91.1% following the repeal of the Affordable Care Act penalty for Americans who don't purchase health insurance.