Overnight Health Care — Sponsored by PCMA — Judge orders Maine to implement Medicaid expansion

Overnight Health Care — Sponsored by PCMA — Judge orders Maine to implement Medicaid expansion
© Getty Images

Welcome to Overnight Health Care, sponsored by the Pharmaceutical Care Management Association


It's Monday in Washington, where everyone is debating whether the president can actually pardon himself. But there's plenty of health care news on the agenda as well.


The big story, though, takes us to Maine, where a state court is ordering officials to begin implementing Medicaid expansion.

The details: A Maine court has ordered the state to move ahead with Medicaid expansion, which was approved by voters last year but blocked by Republican Gov. Paul LePage. The judge asked the state to produce a plan by June 11 on how it will expand the program.

Backstory: Maine was the first state to expand Medicaid through a referendum. But LePage has fought those efforts at every turn, arguing that it would be too expensive. Critics, though, question his estimate.

We'll have more on the late-breaking story here.



Sponsored content - Pharmaceutical Care Management Association

Pharmacy benefit managers (PBMs) are hired by employers, unions, and government programs to negotiate aggressive discounts from drug companies and drugstores.   Learn how PBMs are part of the solution to reducing Rx costs at DrugBenefitSolutions.com.




Also today, New York ObamaCare insurers are asking state regulators to approve an average rate hike of 24 percent.

Meanwhile, 11 insurers in Washington state want to increase premiums by an average of 19.08 percent.

Why it matters: Insurers in both states blame recent and upcoming changes to the law. In New York, insurers are concerned about Congress' repeal of the individual mandate, which takes place next year, and in Washington, insurers are concerned that looking action from the Trump administration could draw healthy people from the markets.

Context: We're likely to see this trend continue for weeks or months to come as insurers finalize their rate requests. But remember, rates still need to be approved by state regulators. And those who receive subsidies to buy insurance will mostly be shielded from any increases. It's those who make too much to qualify for subsidies who will be most affected.

We explain here.


Inspector general finds surge in Medicare drug spending

Advocates for lower drug prices got some new fodder on Monday with an HHS inspector general report finding a surge in drug spending despite a drop in the number of prescriptions.

Key findings:

  • Medicare Part D spending for brand-name drugs rose by 62 percent from 2011 to 2015, from $49 billion to $80 billion.
  • That occurred even though the number of prescriptions fell 17 percent in the same time period.
  • Unit costs for drugs rose 29 percent from 2011 to 2015, six times faster than inflation.
  • Medicare enrollees' average out of pocket costs per brand name drug rose from $161 to $225 in that time period, an increase of 40 percent.

Key quote: "Today's report from the HHS Inspector General makes it clear that list price increases on brand drugs are hurting patients," said David Mitchell, founder of the advocacy group Patients for Affordable Drugs. "I heard this weekend from a California woman who reports she pays $500  -- nearly half of her $1,200 per month income -- to cover two maintenance drugs. We need action to lower pharma list prices now."

Read more here.





A federal judge over the weekend ruled against the Trump administration in a class action lawsuit filed by dozens of organizations working to prevent teen pregnancy.

The Department of Health and Human Services last year told participants in the Teen Pregnancy Prevention Program that their five year grants would be ending two years early, calling the program ineffective.

This move prompted lawsuits, including the class action suit filed by 62 grant recipients.

Judge Kentanji Brown Jackson of the U.S. District Court for the District of Columbia ruled over the weekend that the terminations were unlawful and HHS should proceed "as if the agency had not undertaken to shorten these grantees' federal awards."

What it means: HHS will have to accept and process applications from grantees for their final two years of funding. It appears that grantees will be able to follow funding requirements set by the Obama administration, not new criteria issued under Trump that is focused more on abstinence.

What to watch for next: Supporters of the program are waiting with baited breath, though, for HHS to decide its next steps, which could include an appeal.

What HHS is saying now: From an agency spokesperson:

"We are disappointed with this ruling," HHS spokesperson Caitlin Oakley said in a statement. "Continuing the program in its current state does a disservice to the youth it serves and to the taxpayers who fund it. Communities deserve better, and we are considering our next steps."



Sponsored content - Pharmaceutical Care Management Association

The Congressional Budget Office's $43 billion score of point-of-sale rebates in Medicare Part D is the latest in a series of official estimates showing this mandate would increase costs for the government and taxpayers. This score strikes the third blow to the drugmakers' multi-million dollar campaign to shift blame for their own prices onto the health plans and pharmacy benefit managers (PBMs) that negotiate discounts and rebates to reduce costs.



CMS rolls out Medicaid scorecard

CMS Administrator Seema Verma on Monday unveiled a new "scorecard" that provides data on different aspects of state Medicaid programs. The goal is to hold the program accountable, so "every American [can] see how well the Medicaid program is doing," Verma told reporters Monday.

The National Association of Medicaid Directors, though, said they had concerns about the "comparability, accuracy and timeliness of the data."

Another tidbit from Verma's briefing: She declined to comment on what President TrumpDonald John TrumpSunday shows preview: Trump sells U.N. reorganizing and Kavanaugh allegations dominate Ex-Trump staffer out at CNN amid “false and defamatory accusations” Democrats opposed to Pelosi lack challenger to topple her MORE meant when he said drug companies would soon be announcing voluntary price decreases. She said she did not want to get in front of any announcements.


From the weekend:

Blue states are defying the Trump administration in a bid to protect ObamaCare.

Virginia's expansion of Medicaid this week is giving hope to advocates in other states.


What we're reading

'Medicaid-for-All' rapidly gains interest in the states (Governing)

Mail-order pharmacy system delays meds for some patients (Columbus Dispatch)

U.S. postal stamp helped fund key breast cancer study (NBC News)


State by state

Four states could expand Medicaid this year. That's a big deal. (Vox.com)

Health care simmers on back burner In California heartland's hot House races (The Washington Post)

How a reshaped Virginia legislature learned to love Medicaid expansion (The Washington Post)