🔥A must-read: ⁦@oncologyCOA⁩ report on #PBMs

Some takeaways:

“…PBMs make up an oligopoly of rich, vertically integrated conglomerates that routinely prey on health care practices, providers, and their patients.”
2/ “PBMs have done this by overwhelmingly abusing their responsibility to protect Americans from this country’s drug pricing crisis, instead exploiting the opacity throughout the nation’s drug supply chain to enrich themselves.”
3/ “[The report] explores how the recent levels of consolidation among PBMs and health insurers is adversely impacting #cancer care, fueling drug costs, all while allowing for massive profits for #PBMs and health insurance companies.”
4/ “Examining the most pervasive and abusive #PBM tactics, each section highlights the adverse impact of PBMs on #patients, health care payers (including #Medicare, #Medicaid, employers, and taxpayers), and providers, while also detailing potential solutions.”
5/ “[Solutions] include legislative efforts at both the state and federal levels…regulators (both state and federal) have tremendous tools available to them, that up until this point, have not been widely utilized.”
6/ To read the @oncologyCOA report, “Pharmacy Benefit Manager Exposé: How PBMs Adversely Impact Cancer Care While Profiting at the Expense of Patients, Providers, Employers, and Taxpayers.” please see:
communityoncology.org/wp-content/upl…

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More from @MarilynHeineMD

May 25
🧵⬆️ evidence that insurer-imposed authorizations for drugs & medical services can be a hazardous & burdensome administrative obstacle to patient-centered care.

Yet “…health insurer industry continues to show apathetic or ineffectual follow-through on mutually accepted reforms” Image
2/ “Prior authorization requirements should be selectively applied to physicians based on demonstrated adherence to evidence-based guidelines and quality measures, according to the consensus statement.” But happens in only 9%. Image
3/ The list of drugs and services that require prior auth should be regularly reviewed by insurers to remove items that show "low variation in utilization or low prior authorization denial rates," per consensus statement.

But, high & ⬆️ drugs, med services requiring prior auth. Image
Read 9 tweets
Apr 28
🧵 ⁦@AmerMedicalAssn⁩ Prez ⁦@GeraldHarmonMD⁩ stated:

An investigation by ⁦@OIGatHHS⁩ “into the inappropriate use of #PriorAuthorization by Medicare Advantage plans uncovered information that mirrors physician experiences.”

Read report: oig.hhs.gov/oei/reports/OE…
2/ “Surveys of physicians have consistently found that excessive authorization controls required by health insurers are persistently responsible for serious harm when necessary medical care is delayed, denied, or disrupted.” #FixPriorAuth

See 2021 survey: ama-assn.org/system/files/p…
3/ “The American Medical Association agrees with the federal investigators’ recommendations for preventing inappropriate use of authorization controls to delay, deny and disrupt patient care, but more needs to be done to reform prior authorization.”
Read 9 tweets
Dec 10, 2021
🧵👏👏Patients & Physicians Grateful for #Congress Fending Off #Medicare Cuts

“These automatic cuts should remind members of the needed reforms. Congress can get a head start on doing the right thing when it reconvenes early next year.”

AMA statement: tinyurl.com/2wtbarfc
2/ Last evening, the Senate passed legislation to halt Medicare physician payment cuts that were scheduled to take effect on January 1. President Biden is expected to sign the bill into law.

Highlights of the physician payment provisions include the following: 👇
3/ a. Delay in resuming 2% Medicare sequester for 3 months (1/1- 3/31/2022), followed by a reduction to 1% for 3 months (4/1-6/30/2022).

b. 1-year increase in the Medicare Physician Fee Schedule of 3% (0.75% less than the conversion factor boost provided for 2021).

…and
Read 4 tweets
Dec 9, 2021
🧵⁦@AmerMedicalAssn⁩ ⁦@ahahospitals⁩ representing physicians, hospitals, and health systems sued the federal government today over the misguided implementation of the federal surprise billing law, No Surprises Act. The final rules jeopardize access to patient care.
2/ The associations are joined in the suit by plaintiffs including Renown Health, UMass Memorial Health and 2 physicians based in North Carolina.

The lawsuit challenges a narrow but critical provision of a rule issued on 9/30/2021 by @HHSGov @USDOL @USTreasury.
3/ The AMA press release states:

• “The provision being challenged ignores requirements specified in the No Surprises Act and would result in reduced access to care for patients. The rule and this flawed provision are set to take effect Jan. 1, 2022.”
Read 16 tweets
Dec 2, 2021
🧵New report from ⁦@AmerMedicalAssn⁩ documents UNPRECEDENTED changes in #Medicare spending as people decided to delay or forgo #healthcare services during onset of #COVID19 pandemic.

👉Read tinyurl.com/2uhu4vv5

🎇Warrants urgent action by Congress to stop Medicare cuts Image
2/ Despite a mid-year rebound after sharp declines early in the year, Medicare spending on physician services during 2020 NEVER RECOVERED to its pre-pandemic trend.

Struggling physician practices face a difficult and precarious road to recovery.

tinyurl.com/358y86bx
3/ Widespread ⬇️ spending on physician services:

“When compared to expected Medicare spending on physician services, the AMA report found that actual Medicare spending on physician services for 2020 declined regardless of service type, setting or specialty, and state or region.”
Read 8 tweets
Dec 2, 2021
🧵Statement from ⁦@AmerMedicalAssn⁩:

🔥Congress fails patients and physicians on Medicare cuts

“Physicians have warned #Congress for months about the pending and perilous Medicare cuts coming on January 1.”

@SpeakerPelosi @GOPLeader @SenSchumer@LeaderMcConnellImage
2/ “Yet, the end of the year is quickly approaching and it is clear that #Congress is not prioritizing support for the nation’s health care providers who have been on the front lines of the #COVID19 #pandemic.”
3/ “Throughout the ongoing #pandemic during which physicians have risked their own health and grappled with significant financial instability, #Congress is poised to allow a 10 percent #Medicare cut to take effect.”
Read 7 tweets

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