Latest California Healthline Stories
Pharmacies Face Extra Audit Burdens That Threaten Their Existence
Pharmacy benefit managers have curtailed in-person audits of pharmacy claims during the pandemic, switching to virtual audits done by computer. That has markedly increased the number of claims they can review — and the chances for payment denials — squeezing pharmacies and bringing in more cash for the benefit companies.
KHN’s ‘What the Health?’: Delta Blues
Covid is back with a vengeance, with some people clamoring for booster shots while others harden their resistance to getting vaccinated at all. Meanwhile, the Food and Drug Administration is pushing hard on drugmaker Pfizer’s request to upgrade the emergency authorization for its vaccine and give it final approval. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, for “extra credit,” the panelists suggest their favorite health policy stories of the week they think you should read, too.
2+2=? Senate Uses Murky Math as It Shelves Drug Pricing Rule to Fund Infrastructure
The Medicare rule, designed by the Trump administration to take money away from drug industry brokers and provide refunds to patients, has not been implemented. But budget analysts say if it were, it would cost the government money. So senators are pushing the rule aside and claiming to save billions of dollars, which they want to use instead on new projects.
Diabetes Drug’s New Weight Loss Formula Fuels Cost-Benefit Debate
Health plans’ coverage of the medication, branded as Wegovy — which has a $1,300-a-month price tag — is not a sure thing.
Pfizer Court Fight Could Legalize Medicare Copays and Unleash ‘Gold Rush’ in Sales
Pharmaceutical companies routinely cover the cost of patient copays for expensive drugs under private insurance. A federal judge could make the practice legal for millions on Medicare as well.
As Holdout Missouri Joins Nation in Monitoring Opioid Prescriptions, Experts Worry
Missouri is the last state to create a monitoring program to help spot the misuse of prescription drugs. But some public health experts warn that the nation’s programs are forcing people addicted to opioids to seek deadlier street options.
Journalists Dig in on Delta Variant Risks and Opioid Overdose Deaths
KHN and California Healthline staff made the rounds on national and local media this week to discuss their stories. Here’s a collection of their appearances.
Facing Headwinds on New Alzheimer’s Drug, Biogen Launches Controversial Campaign
The makers of Aduhelm, a drug approved last month despite concerns raised by experts about its effectiveness, have launched a website and ads designed to urge people who are worried about their memory to ask doctors about testing. But some health advocates say it is misleading because some memory loss with aging is normal.
Analysis: Necessary or Not, Covid Booster Shots Are Probably on the Horizon
In today’s pharmaceutical universe, a simple “safe and effective” determination by the Food and Drug Administration to approve a drug can be manipulated to sell products of questionable value. And drugmakers can profit handsomely.
Sen. Wyden: $3.5T Budget May Have to Trim but It Can Set a Path to ‘Ambitious Goals’
Sen. Ron Wyden (D-Ore.), who is helping to negotiate the health care spending framework for the Democrats’ budget plan, said lawmakers may have to settle for very basic versions of programs deployed in the package. But the key, he added, is to get the “architecture of these changes, bold changes,” started and show people what is possible.