Archive for February, 2021


Medicare Pays Far More Than Medicaid for Brand-Name Drugs

Medicare pays three times as much for brand-name drugs at retail pharmacies as Medicaid and two-and-a-half times more for specialty drugs, according to a new analysis by the Congressional Budget Office.

The vast difference occurs because of how drug prices are established for the two programs.  Under Medicare Part D, individual payers and manufacturers negotiate prices based on commercial market conditions while for Medicaid, federal law requires manufacturers to provide rebates.

Learn more about the differences between Medicare and Medicaid prescription drug prices, how and why those differences occur, and their implications in the CBO report “A Comparison of Brand-Name Drug Prices Among Selected Federal Programs.”


Coronavirus Update for Thursday, February 25

The following is the latest COVID-19 information from the federal government as of 2:45 p.m. on Thursday, February 25.

The White House


Department of Health and Human Services

  • HHS’s Office of Civil Rights will not impose penalties for non-compliance with HIPAA rules involving covered health care providers or their business associates in connection with the good faith use of online or web-based applications for the scheduling of individual appointments for COVID-19 vaccinations during the COVID-19 emergency.  See HHS’s formal announcement of this policy.
  • HHS’s Office of Civil Rights has settled three discrimination complaints against a health system that denied

ACA Medicaid Expansion Cut Young Adult Uninsurance in Half

The number of uninsured young adults fell nearly 50 percent after the Affordable Care Act authorized states to expand their Medicaid programs, a new study has found.

According to the Urban Institute, the uninsured rate among people between the ages of 19 and 25 fell from 30.2 percent to 16 percent between 2011 and 2018, with most of the decline coming between 2013 and 2016, when the first round of states expanded their Medicaid programs.

The decline in the rate of uninsured young adults mirrored declines in the overall U.S. uninsured rate, which fell from 27.7 percent to 11.3 percent in states that expanded their Medicaid programs.

Learn more about how implementation of the Affordable Care Act affected the insurance status of young adults in the Urban Institute report “Impacts of the ACA’s Medicaid Expansion on Health Insurance Coverage and Health Care Access Among Young Adults.”…

Hospitals Starting to Comply With Price Transparency Requirement

One out of every three hospitals is in full compliance with a federal mandate to post payer rates publicly and transparently.

And many others are partially in compliance with the federal requirement that took effect on January .

Full compliance requires that the postings are machine-readable and include payer-negotiated rates for 300 “shoppable services.”  2000 of 6000 hospitals are already meeting four of five federal criteria and about 20 percent appear to be on their way to doing so.

Hospitals began working to comply with the new federal mandate when their attempt to block it in court failed.

Learn more about how hospitals are responding to the mandate to move toward price transparency in the Fierce Healthcare article “Analysis:  Roughly 2,000 hospitals fully compliant with new price transparency rule.”


GAO Looks at “Medicaid in Times of Crisis”

The federal government often turns to Medicaid to address problems, mitigate damage, and serve vulnerable populations, especially in times of crisis.

In a new issue brief, the U.S. Government Accountability Office looks at examples of how states and the federal government have turned to Medicaid in times of crisis and some of the policy considerations underlying those actions.  Find these examples in the new GAO report “Medicaid in Times of Crisis.”…