Issue 24

Upcoming Forum All-Stakeholder Meeting on August 31st

Mark your calendar for the upcoming Forum Member All-Stakeholder meeting on August 31, 2023 focusing on PMB Transparency! Lauren Vela, who has deep expertise in the employer-related PBM space; Mike Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions; and Greg Baker, CEO of AffirmedRX, will give presentations.

Afterwards, we want to hear from you during a one hour open panel discussion, which will have additional PBMs as panelists, regarding solutions/next steps. Calendar invitations for this meeting will be sent to members.

Presentations

In July, Gloria Sachdev was invited to give presentations regarding policy ideas to advance transparency, affordability, and competition to the following organizations:

• July 12: Indiana State Association of Health Underwriters
• June 13: Louisiana Healthcare Quality Forum
• July 14: LHD Benefit Advisors Conference
• July 20: Georgetown University

Thank you for the opportunity to present!

Ongoing Challenges with Hospital Price Transparency

In a recent study, KFF found that generally the hospital MRF data are challenging to use for several reasons:

• Specification of what services prices correspond with is inconsistent, especially for episodes of care (e.g., negotiated rates attached to a treatment episode for a hip/knee replacement might correspond to a per diem charge instead of the entire episode).
• Data quality can vary widely, with questionably low and high values for negotiated rates (e.g., negotiated rates representing a proportion or multiplier of a rate may appear as less than one dollar).
• Crucial pieces of information for interpreting the applicability of price are missing, such as contracting method and payer class (Medicare, Medicaid, and commercial), as certain payer classes generally have lower rates.

Read the full article here.

NASHP Toolkit: State Action on Pharmacy Benefit Managers (PBMs) to Address Prescription Drug Pricing

This toolkit by NASHP is a resource for employers and policymakers interested in strategies to address prescription drug prices through pharmacy benefit manager (PBM) regulation and oversight. This toolkit includes legislative tracking and analysis resources from NASHP as well as state legislation and policy reports. View the toolkit here.

U.S. Chamber of Commerce Files Motion for Preliminary Injunction on Medicare Drug Negotiation

Unfortunately, the U.S. Chamber of Commerce, one of the largest lobbying groups in the country, filed a motion Wednesday for a preliminary injunction to block the implementation of the Medicare Drug Price Negotiation program established by the Inflation Reduction Act (IRA), which is currently facing an onslaught of legal challenges. Read the full article here.

Directions and Success Factors in Onsite, Nearsite and Virtual Health Centers

For Forum members interested in learning more about onsite clinic opportunities, the NAWHC has their 11th Annual Forum, September 7-8, 2023, at Radisson Blu Mall of America in Bloomington, Minnesota. Learn more and register here.

Congrats to our Indiana Hospitals for Receiving a 5-Star CMS Quality Rating!

CMS updated its Overall Hospital Quality Star Ratings for 2023, awarding 483 U.S. hospitals with a rating of five stars as of July 26. This year, 54 more hospitals were given 5 stars than in 2022. A 5 star rating is the highest quality rating CMS gives.

The graphic shows a list of the Indiana hospitals that received a five-star rating from CMS, pulling from data on the Hospital Compare website. For a list of all states, visit this link.

Darren R. Covington, J.D.

Executive Vice President
Indiana Pharmacy Association

“Since January 2020, I’ve served as Executive Vice President of the Indiana Pharmacy Association. I previously served as Director of the Indiana Board of Pharmacy and Medical Licensing Board of Indiana, and started my career as a Deputy Attorney General in the Indiana Attorney General’s Office. I was raised in Indianapolis, but have lived in Greensburg for 15 years. My wife, Abbie, and I have a five year old, who is starting Kindergarten this year.”

What is something that motivates you in your career?

I love to learn! I can be hesitant to try new roles, but when I do, I want to learn and develop as much expertise as I can. My current role has allowed me to learn and develop skills I thought I’d never have to do. I joke that in one day I go from being a webmaster, to a marketing specialist, to an accountant, to drafting policies, to strategic planning, and more. Additionally, IPA is filled with such passionate people and being able to help support their dreams is very rewarding.

What has been your favorite project you have worked on in your career?

It is hard to pick one. I’ve been fortunate to have had so many different experiences. I’ve had a non-traditional path for an attorney. If I had to pick one though, my favorite has been advocating on behalf of pharmacists at the Statehouse to achieve real practice advancement for them. The teamwork, the passion, the opportunities to educate, being able to play a part in the political process – all of that makes every day unique, challenging and rewarding. As a student, I had a dream of someday working at the Statehouse, and being able to realize that now has been fulfilling.

If you could spend a summer anywhere in the world, where would it be?

I would love to be able to visit all the national parks out west, although maybe not during the summer heat!

Employers:

• Employers are Increasingly Suing Their Health Plan for Claims Data (Beckers)
• Employer Lawsuits Heat Up Against Health Plan Administrators (Bloomberg Law)
• Stage Set for ‘Bloodbath’ Insurer-Employer Contract Negotiations (Modern Healthcare)

Hospitals

• Indiana Hospital Ending Heart Transplants, Inpatient Burn Care (Beckers)
• Indiana Hospital Closing Emergency Department, Ending Inpatient Services (Beckers)
• Indiana Hospital Shooting Left 2 Dead, Including Police Officer (Beckers)
• As Nonprofit Hospitals Reap Big Tax Breaks, States Scrutinize Their Required Charity Spending (KFF)
• Riverview Health CEO Anticipates Growth Despite Recent Red Ink (IBJ)
• Doctor’s Office Care at Hospital Prices (WSJ)

Insurers

• UnitedHealthcare to Offer Eligible Members 24/7 Virtual Visits at No Additional Cost (UHC)
• Cigna Lawsuit Over Algorithm Allegations Could be First of Many (Modern Healthcare)
• UnitedHealth Group Posts $5.5B Profit in Q2 (Beckers)
• Elevance Health Profits Hit $2 Billion As Insurer Adds 1.3 Million Members (Forbes)
• Largest Health Insurance Companies of 2023 (Value Pengiun)

Providers & Physicians

• Indiana Supreme Court: Lawmakers Can Ban Abortion Except to Protect Mother’s Health (Indy Star)
• 20 Largest Physician Groups by Locations (Beckers)
• Fewer Physicians are Owning Practices. Here’s Why (Modern Healthcare)
• Providers Reconsider Noncompetes Ahead of Proposed FTC Ban (Modern Healthcare)
• Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice (JAMA)
• Who Values Human Capitalists’ Human Capital? The Earnings and Labor Supply of U.S. Physicians (BFI)

Pharmacy

• Drugmakers Warn New Law Will Deter Discoveries (IBJ)
• Drugmakers Want to Stop Medicare from Negotiating Prices. Here’s What You Should Know (CBS58)
• FDA Finds Multiple Faults at Second-Biggest Indian Drugmaker (Bloomberg)
• New Alzheimer’s Drugs Spark Hope for Patients and Cost Concerns for Medicare (KFF)
• Four Crucial Questions about the Humira Biosimilar Price War (Drug Channels)
• 340B Pay Remedy Favors Hospitals with the Least Uncompensated Care (Modern Healthcare)
• Medical Debt Is Making Americans Angry. Doctors and Hospitals Ignore This at Their Peril (KFF)

Other Healthcare News

• 11 Highest-Paid Healthcare CEOs: Their Paths to the Top (Beckers)
• Largest Indiana Employers (IBJ)
• Nonprofits in Indiana (ProPublica)
• A Year With 988: What Worked? What Challenges Lie Ahead? (KFF)
• FDA Approves First Daily Over-The-Counter Birth Control Pill in U.S. (Washington Post)