A private business, Apexus, has helped supercharge the controversial federal drug program, 340B. Patients and insurers have been left with big bills. The intention behind the program was for a small number of safety-net providers to have access to affordable drugs and be able to expand their care for needy patients. But instead, the program has exploded: Now, more than half of nonprofit hospitals in the United States take part. While some providers say it has helped keep their doors open, others — especially large nonprofit health systems — have been accused of maximizing payouts and swallowing the profits. Source: New York Times

Recent attacks on Medicaid have proposed a per capita cap on federal funding and potentially instituting block grants. While these are not new proposals, this would dramatically change federal and state Medicaid structures by shifting the cost and the risk directly to states. With more and more consumers relying on Medicaid, changes and cuts could leave millions without coverage nationally. Some states have begun the groundwork to reinstate work requirements. In 2019, the Centers for Medicare and Medicaid Services approved 13 Medicaid demonstration projects centered around work requirements as a condition of Medicaid eligibility. Previous research indicated that among enrollees who aren’t already working, nearly all have disabilities, serious health conditions, childcare or caretaking responsibilities, or are in school.

The US Supreme Court has agreed to hear arguments to consider whether the Affordable Care Act’s preventive care coverage should be reinstated after a lower court struck it down. If the court rules in favor of the Texas employers who filed the case, tens of millions of people who get their health insurance from their employer or through the ACA marketplace would be impacted by the removal of these services, which require insurers to cover the full cost of everything from birth control to vaccines to mental health screenings. Since the enactment of the ACA in 2010, more than 2,000 legal challenges have been filed in state and federal courts contesting all or part of the law. While the law remains popular and enrollment in the Health Insurance Marketplaces through the ACA has soared to more than 23 million people, challenges jeopardize the law and its effectiveness.

A free dental salary survey report from DentalPost is now available for download. The report includes nationwide data on income, benefits, hours, turnover, retirement plans, and more for dentists, dental hygienists, dental assistants, and front office specialists. Salary and benefits packages for these disciplines have increased significantly over the past year. See how your salaries compare with the other practices and download your copy of the survey here.

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) announced the availability of $3 million in grant funding to provide integrated, centralized healthcare that addresses both behavioral health and primary health needs for persons with substance use disorder (SUD). The purpose of this initiative is three-fold, including:

·    To promote the integration and collaboration in clinical practice between behavioral health care and primary physical health needs.

·    To support the improvement of integrated care to improve overall wellness.

·    To promote the implementation and improvements of integrated care services, including evidence-based or evidence-informed screening, assessment, diagnosis, prevention, treatment, and recovery services for SUD, opioid use disorder (OUD), and co-occurring physical health conditions and chronic diseases through integrated care.

The goals of this grant opportunity align with Shapiro’s Executive Order establishing the Pennsylvania Behavioral Health Council.

The Substance Abuse and Mental Health Administration (SAMHSA) recently released new resources to promote integration and promising practices in substance use disorder (SUD) treatment. SAMHSA’s Serious Mental Illness Training and Technical Assistance Center (SMI TTAC) also offers training, tools, and resources to improve the treatment of SMI.

The Pennsylvania Department of Health released Health Advisory-782 concerning the health effects of environmental exposures, which can cause a variety of health effects depending on exposure type, source, duration, and individual sensitivity. Exposure routes for environmental contaminants can include contact, inhalation, ingestion, radiation, and transplacental. Certain groups – such as older adults, children, people of color, immigrants, pregnant women, people with disabilities, and people living below the poverty line – are more likely to experience negative health impacts due to environmental exposures. The Pennsylvania Department of Health has compiled a list of training and resources from academic and governmental organizations that can help healthcare providers assess environmental exposures and respond to patient concerns. Individuals can contact the Division of Environmental Health Epidemiology with questions at DEHE@pa.gov or 717-787-3350. To document a formal health concern with the department use its online form. You can also access the PA Health Alert Network (PA-HAN).

The three biggest pharmacy benefit managers (PBMs) made more than $7.3 billion over five years marking up the prices of specialty generic drugs for cancer, HIV and other conditions, the Federal Trade Commission (FTC) charged in a report this week. It’s the second time the FTC has singled out CVS Caremark, Express Scripts, and OptumRx for driving up drug costs. The report could provide fodder if President-elect Trump opts to make good on vows to crack down on pharmacy middlemen. The report found that PBMs marked up prices for specialty generic drugs by hundreds and sometimes thousands of percent over their estimated acquisition costs from 2017 and 2022. Most of the highly marked-up drugs were dispensed at pharmacies affiliated with the PBMs. The three companies almost always reimbursed their affiliated pharmacies at a higher rate for the drugs than unaffiliated pharmacies. The report builds off earlier findings the FTC released in July that found that the three major PBMs garnered nearly $1.6 billion in extra revenue on just two cancer drugs in less than three years by steering business to affiliated pharmacies. Read more about the FTC report on PBMs.

On December 26, CMS approved Pennsylvania’s new 1115 demonstration titled, “Keystones of Health.” The state received authority to provide limited coverage for eligible incarcerated individuals for up to 90 days prior to the individual’s anticipated date of release from state prison or county jail. This approval also provides expenditure authority for certain housing and nutrition-related services to eligible Medicaid beneficiaries based on clinical and social risk criteria. The demonstration is effective through December 31, 2029.

The purpose of MA Bulletin 99-25-01 is to advise providers that the Pennsylvania Department of Human Services (Department) has updated the top 15 non-English languages used by Medical Assistance (MA) beneficiaries and to issue a revised top 15 non-English language tagline document. Additionally, this bulletin reminds providers of their responsibility to provide interpretation and translation services free of charge to all individuals who have Limited English Proficiency (LEP), vision limitations, and/or auditory limitations, and the federal guidelines that must be followed to accomplish this.