Of Note Health Roundup
can you guess which telehealth execs got arrested for healthcare fraud?
Happy Sunday! I’m back in Marseille from a weekend road trip along the French Riviera! We have a healthcare roundup for this week’s letter, written while watching The Devil Wears Prada and missing New York City. I’ll see you all next month.
Bernie Sanders is once again defending your rights (Washington Post)
Among other covered preventive services, the Affordable Care Act required that health insurance plans offer birth control free of charge. This doesn’t always work as planned. People often end up paying for their birth control, so Bernie is using his position as the HBIC of the Senate Health Panel to call for the Government Accountability Office to look into the issue better and why it happens. This is likely the result of two ACA policy drawbacks: vague criteria and limited policy oversight/accountability. To save costs on drugs, insurers use formularies and may place some branded birth control drugs higher on the formulary. However, sometimes people react better to the branded version of their prescription. Patients and their doctors can appeal to get it covered, but many people don’t know this and still pay out of pocket for drugs that should be free.
California’s billion-dollar Medi-Cal negotiation (KFF)
Medi-Cal is California’s version of Medicaid (CMS program refresher: we care for the elderly, Medicare! We aid the poor, Medicaid!). Two out of five Californians rely on Medi-Cal, but reimbursement rates are low for an already stretched and burnt-out healthcare workforce. Thus, healthcare providers often opt out of accepting Medi-Cal patients. To address this issue, Newsom + Bipartisan Co proposed using funds from the Managed Care Organization tax to increase payment for Medi-Cal providers. California’s healthcare leaders support it, but KFF reports that Gav may have had a change of heart given the state’s financial deficit and wants to use most of those funds to make up for state overspending. Tensions are high!
Tech bros committing healthcare fraud? Say it ain’t so! (NY Times)
The DOJ came for Done, a telehealth company for allegedly prescribing ADHD drugs to people who didn’t need them and billing their insurance companies fraudulently. I feel like you all know there’s a shortage, so I won’t get into that. This is why we can’t have nice things…
On that note, DEA round two of telehealth controlled substance prescription regulation (Fierce Pharma)
The pandemic pushed the boundaries for telehealth, which is overall a good thing. After this year, flexibility on telehealth prescriptions will end and the DEA was tasked with regulating telehealth prescriptions for controlled substances. The latest version of this rule heeds comments from last year’s public sessions. Next, the OMB will review and run the numbers before opening for public comments.
Japan has a super-aging population and low birth rates. Tokyo Governor incumbent, Yuriko Koike + her challenger Renho Saito have proposed subsidizing epidurals and childcare to boost their chances of winning at the ballot box. Koike has a track record of investing in policies to improve Tokyo’s fertility rate, including a government dating app and egg-freezing subsidies. The trick about the dating app is you have to promise you want to get married, New York City could NEVER make this work.
Back to regular programming next week!
xxsem