Photo: Carla K. JohnsonCraig Garthwaite, assistant professor, Northwestern University’s Kellogg School of Management (left); Roy Guharoy, Pharm.D. vice president and chief pharmacy officer for the Resource Group at Ascension (middle); and independent journalist and AHCJ member Duncan Moore (right) spoke at the Chicago chapter event “Drug Pricing: Covering the Controversy” at Columbia College in Chicago on Feb. 23.
A blockbuster hepatitis C drug costs $84,000, straining state budgets. Martin Shkreli acquires the rights to a generic and raises its price 5,000 percent. Presidential candidates react to the public outcry, claiming they know what to do about the drug prices.
What does it all mean? Until recently, “there’s been an equilibrium in the public mind between a free market regimen of the market setting prices and what the public and payers are willing to pay,” said independent journalist Duncan Moore, “but there are indications this informal tradeoff has begun to swing out of control.” Continue reading
While much of America was watching the New York Mets and Kansas City Royals battle it out for 14 long innings Tuesday night, House Republican leadership and the White House were battling out a budget compromise.
The agreement still must be approved by the full House and the Senate. Update: The House passed the bill with a 266 to 167 vote late Wednesday and the Senate approved it on Friday.
The bill funds federal government for the next two years and avoids a potential government shutdown. The deal plugs an impending hole in the Social Security disability trust fund. Without it, millions getting disability would have seen their benefits significantly cut. It also staves off a potentially historic increase in Medicare for Part B premiums for about 15 million beneficiaries.
The Medicare provision stalls a scheduled cut to the rates doctors get paid under Medicare by law for three months. Legislators hope to come up with a permanent fix to slow Medicare costs. Continue reading
This week marks the start of Medicare’s open enrollment period, when beneficiaries can shop for a Medicare Advantage (MA) or Prescription Drug Plan (PDP) for 2016. Open enrollment happens every year from Oct. 15 through Dec. 7.
The Centers for Medicare & Medicaid Services is encouraging people with Medicare to check whether they’re getting the best price and quality plan available based on their current and anticipated health needs. Continue reading
Some low-income seniors who qualify for both Medicare and Medicaid — the dual eligibles — have the chance to age in place in their communities thanks to Medicaid’s coverage of long term services and supports (LTSS). This is especially important for older adults who are juggling multiple chronic conditions and may require help with activities of daily living, like bathing, dressing, or eating.
This is a population at high risk for needing expensive institutional care, and is not the preferred site of care for most people. Community-based LTSS avoids institutionalizing many older adults and is a more cost-effective solution to the growing aging population. Continue reading
The job of a journalist is to seek the truth and report it. To provide comprehensive and fair accounts of issues. This mantra is written into the codes of ethics of journalism organizations worldwide.
However, when government officials throw up roadblocks, refuse to answer basic questions, and rely on excuses to thwart legitimate investigations into policy, presenting the whole truth to the public is nearly impossible. When requests for documents under the Freedom of Information Act are ignored, or responses delayed indefinitely, then it may be time to start filing legal challenges.
Such was the case with the Center for Public Integrity’s investigation into Medicare Advantage plans. Reporters tried for months to speak on the record with officials at CMS about the program’s financial probes and other oversight issues. CPI eventually filed Freedom of Information Act requests to get supporting documentation.
When CMS failed to respond after a year, CPI sued. Is this the only way to get government and other public organizations to open up their records? According to this tip sheet from Fred Schulte, it depends.