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There may be a hidden way to pay for uninsured care from Covid-19
When HHS abruptly closed its Covid-19 care payment program for the uninsured, it left hospitals, pharmacists, clinics and testing companies stranded. HHS paid more than a billion dollars a month.
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But at least for some facilities, there may still be a way to cover some of these costs.
Experts say FEMA reimburses some costs for testing, vaccines and treatments if there is no other payer - although using that would be a big administrative headache. It is not open to everyone, because only non-profit health care providers qualify, and the paperwork for them would be much more rigorous than it was under the HHS program. Read more about the possibilities and pitfalls of the option in my latest story, here.
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The Senate Mental Health Bill is good news for digital health companies
This morning, a bipartisan group of senators proposed lifting restrictions on access to mental health services for the elderly through telehealth - a move that will be music to the ears of digital health companies that flourished during the pandemic.
Congress decided to make permanent coverage of Medicare telementation services in 2020, but added that seniors had to see their service provider in person for the past six months. The telehealth industry has aggressively lobbied to repeal the provision before it takes effect, which should happen when the HHS ends the pandemic emergency rules. I have all the details of the other provisions here.
Hospitals continue to buy proton beams, even with unstable benefits and questionable profitability
The arms race for prestigious medical centers to build their own proton beams continues, despite the fact that it is a risky investment that can increase costs, my colleagues Bob Herman and Tara Bannou report in a new story this morning.
One factor driving the gold rush of proton therapy is a decision by Medicare many years ago that allowed centers to raise tens of thousands of dollars to treat some patients who could receive other, cheaper forms of radiation that work equally well.
And while some centers are doing well, there are a number of non-payment bonds and bankruptcies funded by obscure entities with changed results. Get the full, dishonest picture of the industry in their fascinating new deep dive.
Bad week for insurers in California
This week, California senators proposed not one, not two, but three laws intended for reckoning with health insurers, reports my colleague Nick Florko.
Accounts would do the following:
- Outlawed “white bag”, a process in which health insurers team up with specialized pharmacies to send patients’ infused drugs directly to the hospital, instead of relying on the hospital’s own pharmacy. Insurers say the process helps reduce drug costs, but hospitals say it often delays care for serious conditions such as cancer.
- Ask the insurer to pay for medication while the patient complains of denial. Health plans say the law would hamper their ability to manage drug prices and increase insurance premiums. Patient advocacy groups say the bill would ensure patients do not have to wait for necessary medications.
- Drastically increase penalties for insurers who break the law. This law would increase the basic penalty for a number of violations - such as denying coverage to patients for sex-affirming care - from $ 2,500 to $ 25,000 per offense, per damaged registrar.
But it is not over yet: none of the bills has yet been moved to the California Assembly.
The carousel price of drugs returns to PBM
This doesn’t happen often: two very powerful bipartisan senators come up with a big new bill that could encourage the FTC to follow the pharmacy benefits manager’s business practices more closely (a saga my colleague Ed Silverman covered extensively). Here, too, their board tasks are important: Sens. Maria Cantwell (D-Wash.) And Chuck Grassley (R-Iowa) are leaders on two committees that oversee the FTC itself and antitrust matters, which gives this bill far more legs than your average two pager. We’ll watch - stay with us.
What we read
- While researchers are looking for answers about the symptoms of return after treatment with Paklovid, Pfizer announces that it will sell its vaccines and drugs at non-profit prices to poor countries, STAT
- Democrats are once again focusing on drug prices after the primary changes in Oregon, Washington Post
- Now that public health measures to slow down Covid-19 have been relaxed, other viruses and diseases are returning with revenge, STAT
- HHS Secretary Xavier Bessera officially founded ARPA-H within the NIH and appointed University of Maryland scientist Adam Russell as Acting Deputy Director, Bloomberg Love