At the beginning of the year, California’s governor signed an executive order directing DHCS to adopt a fee-for-service model for Medi-Cal. Under the order, California would consolidate its purchasing power and leverage the state’s population size to achieve lower drug costs by purchasing in...
Since state Medicaid programs are responsible for the healthcare of several populations, skyrocketing prescription drug costs have become a major budgetary concern. Currently, health care spending is dominating many of their budgets and on a per capita basis, inflation-adjusted retail prescription drug spending has increased...
Medicaid has been designated a high-risk program by the GAO since 2003 due to its size, growth, diversity and oversight challenges regarding improper payments, appropriate use of program dollars, and data. In fiscal year 2018, improper payments represented about 9.8% of the program's total spending...
The Trump administration released its 2020 budget proposal on Monday and it gives some insight into the president’s priorities. The budget includes $1.9 trillion in cost savings for Medicaid and other safety net programs. According to the administration, A Budget For A Better...
In 2018’s legislative session, 45 laws were passed by 28 states to address the problem of prescription drug costs. Apart from these legislative efforts, administrative actions are also being taken to improve the management of Medicaid pharmacy benefits spending. Ohio, West Virginia, and California are...
2018 witnessed a wave of healthcare mega-mergers. One of the most significant acquisitions was between CVS Health and Aetna for $69 billion dollars. The PBM announced its plan to merge with one of the nation’s largest health insurance providers in December of 2017. Following the...
Last year, there were multiple attempts to reform the Medicaid program. While efforts at the federal level met resistance, multiple reform initiatives took place at the state level. These measures included legislation, program expansion, demonstration waivers, eligibility restrictions, and work requirements. Some of these changes...
California’s newly elected governor; Gavin Newsom (D) has recently made a legislative step to address skyrocketing drug prices. Shortly after he was sworn in last week, Newsom signed an executive order making the state responsible for negotiating drug prices directly with pharmaceutical companies. In addition,...
The future of the Affordable Care Act (ACA) is in jeopardy after a federal district court judge ruled the law unconstitutional. On Friday, Judge Reed C. O’Connor (TX) sided with twenty Republican legislators and ruled the law unconstitutional after congress passed the December 2017 tax bill. Last years...
Medicare and Medicaid accounted for $40 billion dollars in improper payments last year and the Medicaid program has been on the GAO’s High Risk List since 2003 due to inadequate fiscal oversight. However, last month CMS announced that the agency achieved the lowest improper payment...
