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This Week in Health Care Reform - July 24th, 2015

A critical group in the care continuum raises the hue-and-cry over the rising price of cancer drugs; more than expected are found to have paid the health care law’s penalty; and, the physician screening process in Medicare gets cited for egregious shortfalls.


Week in Review

Drug Costs: With so much of the conversation to this point surrounding the rising price of prescription drugs having focused predominantly on hepatitis C specialty medicines, new battle lines are beginning to open up, presenting stakeholders across the health care spectrum the opportunity to draw attention to how this unsustainable trend affects a much wider population of patients.  New cholesterol-lowering drugs, representing the most significant advance in heart medication in years, are poised to hit the market.  However, these new medicines have yet to prove their ability to reduce the incidence of stroke or heart attack, but are still expected to be far more expensive than many of the existing drugs that are currently available.  Cancer drugs, which continue to come under heavy fire for their own out-of-control pricing, have drawn the attention of oncologists, with more than a hundred leading experts coming together this week to release a list of proposals aimed at lowering the cost of these drugs.  As the cost of these medications continue to soar, the impact that these runaway prices are having on patients becomes painfully clear, leading to increased pressure for pharmaceutical companies to justify their pricing decisions.

ACA Penalty:
While final figures from this most recent tax year have yet to be finalized, it’s looking like far more people than expected wound up paying the penalty for failing to have health insurance coverage last year as mandated by the Affordable Care Act.  By their latest count, the IRS announced this week that about 7.5 million Americans paid an average fine of $200, resulting in the agency collecting $1.5 billion from tax filers.  The Treasury Department, meanwhile, said that about 300,000 of those who had paid the penalty likely qualified for an exemption and that they will be reaching out to them to let them know that they could potentially save some money by filing an amended return.

Medicare Fraud:
A scathing new report from the Government Accountability Office (GAO) highlights the distressing amount of fraud that’s costing the program billions of dollars.  Released this week, the GAO report identified thousands of instances of medical providers signing up to bill Medicare using questionable addresses.  It also found that dozens of physicians had enrolled in the program despite disciplinary actions from their state medical boards.  While some of the discrepancies could be dismissed as honest administrative error, the report estimates that some $60 billionmore than ten percent of Medicare’s total budget – was lost to fraud, waste, abuse, or improper payments.

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Looking Ahead

This month marks the anniversaries of some very important milestones in our nation’s history.  On Sunday, the Americans with Disabilities Act (ADA) will celebrate 25 years since first being signed into law.  And, next week, the Medicare and Medicaid programs will be commemorating their 50th year of serving our nation’s seniors and low-income populations, prompting some to contemplate the changing future of these critical programs.

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