No Matter How Successful They Are, Drugs With Million-Dollar Price Tags Are Unsustainable, CMS Chief Says
CMS Administrator Seema Verma spoke of her concerns about drugs that cost upwards of $2 million. That kind of innovation doesn't mean anything if people can't afford the treatment, Verma said. In other news from CMS, the agency announced it would crack down on nursing home inspectors.
Verma: Drug 'Innovation Doesn't Mean Anything' If It's Too Costly
CMS Administrator Seema Verma said Thursday that the healthcare system should encourage innovation, but that "innovation doesn't mean anything" if people can't afford and access new drugs and therapies. Verma said that she's worried about the cost and access challenges posed by curative therapies during a discussion panel about healthcare costs at the TIME 100 Health Summit in New York. Curative therapies upend the traditional paradigm of managing disease by curing them instead, but the treatments are costly and unavailable to many patients who could benefit from them. (Brady, 10/17)
CMS Will Crack Down On Nursing Home Inspectors
The CMS announced Thursday that it would bolster the system it uses to hold nursing home inspectors accountable. The agency said in a statement that it will carry out a number of changes to the State Performance Standards System (SPSS) to address concerns about infrequent and ill-timed nursing home inspections. The SPSS will update how it evaluates the performance of state survey agencies who actually inspect nursing homes, as well as update the SPSS assessment tools. (Brady, 10/17)
Meanwhile, in Medicare news —
Kaiser Health News:
Whistleblower Alleges Medicare Fraud At Iconic Seattle-Based Health Plan
Group Health Cooperative in Seattle, one of the nation’s oldest and most respected nonprofit health insurance plans, is accused of bilking Medicare out of millions of dollars in a federal whistleblower case. Teresa Ross, a former medical billing manager at the insurer, alleges that it sought to reverse financial losses in 2010 by claiming some patients were sicker than they were, or by billing for medical conditions that patients didn’t actually have. As a result, the insurer retroactively collected an estimated $8 million from Medicare for 2010 services, according to the suit. (Schulte, 10/18)
The Star Tribune:
Medicare Health Plans Adding More Counties In Minnesota, U.S.
Insurers that sell Medicare Advantage health plans are pushing to extend the coverage into hundreds of new counties across the country next year, a competitive boost that's coming to Minnesota. Minnetonka-based UnitedHealthcare is expanding its Medicare Advantage service area by more than 100 counties next year — an increase of about 6% — and much of the growth comes from Minnesota, where the company is expanding from nine to 43 counties. (Snowbeck, 10/17)