8legs: Medicare

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#1 out of 5

The U.S. named 15 drugs for Medicare price negotiations effective in 2028, under the Inflation Reduction Act.
Biktarvy and Xeljanz are among the drugs selected for price talks, reflecting IRA goals to reduce patient costs.
The 2028 list also includes treatments administered in doctors’ offices and hospitals, such as Cosentyx and Botox.
Analysts say negotiated prices beginning in 2028 could be manageable for the industry.
CMS said the selected drugs accounted for about $27 billion in U.S. spending over the year ending Oct. 31, 2025.
The IRA has sparked court challenges from drugmakers opposing government price setting.
Analysts noted several selected medicines may lose exclusivity soon, affecting pricing dynamics.
The list includes drugs from Gilead, Lilly, AbbVie, Johnson & Johnson, Pfizer, and Bristol Myers
The selection process targeted medicines with reduced generic competition and long development times.
The government hopes negotiated prices will save billions for Medicare residents when fully implemented.
The 2028 negotiations reflect ongoing efforts to curb prescription drug costs under the IRA.

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#2 out of 5

crime1d ago

A Fayetteville man pleaded guilty to conspiracy to pay and receive health care kickbacks in a $3.1 million Medicare scheme.
Klein operated JRS Group LLC and arranged for unnecessary prescriptions obtained through kickbacks and bribes, then took the proceeds for personal use.
Brokers were paid to connect beneficiaries with free prescriptions regardless of medical need.
Doctors conducted telemedicine visits to sign prescriptions Klein had already selected.
Pharmacies paid Klein for referred prescriptions, with documented checks in the hundreds of thousands.
The scheme led to at least $3.1 million in improper Medicare payments, prosecutors say.
Other participants, including an out-of-state doctor and insurance agents, have pleaded guilty.
The U.S. Attorney’s Office for the Western District of New York released the charges and details of the case.
The plea agreement carries potential penalties of up to five years in prison and a $250,000 fine.

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#3 out of 5

health23h ago

Medicare added 15 drugs to its latest price negotiation list, expanding government leverage over pharma pricing.
Pfizer, Novartis and Lilly drugs are now part of the government’s next round of price talks.
Any negotiated prices would not take effect until 2028, limiting immediate revenue impact.
Medicare targets large, established drugs with steady cash flow to pressure pricing long-term.
The move signals ongoing pricing pressure for top pharma brands amid federal negotiation.
The article emphasizes a broader trend of government influence over drug pricing.
The Reuters-originated piece notes a shift in Medicare negotiations impacting major brands.
Drugs named include Botox, Orencia, and Biktarvy among others in the list.
The article cites Medicare beneficiary usage and spending associated with the drugs on the list.
The timing detail clarifies no price changes until 2028 despite ongoing negotiations.

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#4 out of 5

crime12h ago

Dr. Mehmet Oz claims there are 42 hospices within a four-block radius in Van Nuys, Los Angeles.
Oz links Armenian-owned facilities to a multibillion-dollar hospice and home-care fraud scheme.
Governor Gavin Newsom pushed back, saying the claims attack Armenian-owned businesses and misstate fraud scope.
Newsom pointed to past state actions that banned new hospices and revoked licenses to curb fraud.
Oz asserted the Trump administration will not tolerate hospice fraud, citing a crackdown.
Newsom’s office said the allegations are being reviewed amid concerns about hate and targeting Armenian-owned businesses.
The article notes ongoing federal focus on healthcare fraud in California, with few new cases disclosed.
The report emphasizes a clash between political figures over how to address alleged hospice fraud.
The piece situates the claims within a broader narrative of regulating hospice and home-care fraud.

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#5 out of 5100.00%

CMS proposes flat 2027 Medicare Advantage rates and new payment changes, prompting industry pushback.
CMS would restrict chart reviews that add diagnoses to patient records to boost payments.
Kaiser Permanente settlement cited as evidence overpayments through chart reviews.
Experts say chart reviews have driven billions in overpayments for more than a decade.
Industry warns that holding rates flat could lead to benefit cuts for seniors.
CMS says the changes aim to ensure more accurate payments and protect taxpayers.
Government auditors have repeatedly found chart reviews add diagnoses, not delete.
Medicare Advantage enrollment has grown to about 34 million members.
Lawmakers warn about potential senior benefit reductions if rates stay flat.
CMS plans to issue a final decision on rates and provisions by early April.

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