What is in the TMA 3 ruling?
Plus: What codes UHC is cutting prior authorization from
Good morning and happy Friday. This is the Friday Pulse Check from Fulcrum Strategies, your weekly e-newsletter focusing on the healthcare issues that matter to you and your patients.
In the news:
What is in the TMA 3 ruling?
We’ve been waiting for this ruling for a while and this matters a lot to hospital-based radiologists, anesthesiologists, and emergency room physicians. Judge Jeremey Kernodle ruled that the Centers for Medicare and Medicaid Services violated the No Surprises Act when they issued guidance on calculating the Qualifying Payment Amount. Judge Kernodle said that the NSA is very clear when describing how the QPA is supposed to be calculated. He also ruled against the Texas Medical Association when they argued that the QPA should be transparent, but Judge Kernodle said the law is vague and CMS is within their right to issue guidance on that subject.
Ron and I talked about it on this week’s episode of the FLATLINING Podcast from Fulcrum Strategies. You can listen now wherever you listen to podcasts or by clicking the button below.
Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.
The first ten drugs to be “negotiated” by Medicare are announced
The Department of Health and Human Services announced this week the first ten drugs that will be “negotiated” by Medicare. KFF Health News offered some analysis that is a bit more optimistic than what Ron and I have talked about on the FLATLINING Podcast from Fulcrum Strategies, but it provides a good summary nonetheless. Read more from KFF Health News.
The drugs to be “negotiated” are:
LIVE drug stock prices: Novo Nordisk (NVO 0.00%↑), Johnson & Johnson (JNJ 0.00%↑), Amgen (AMGN 0.00%↑), AbbVie (ABBV 0.00%↑), Novartis (NVS 0.00%↑), AstraZeneca (AZN 0.00%↑), Merck (MRK 0.00%↑), Eli Lilly (LLY 0.00%↑), Bristol-Myers Squib (BMY 0.00%↑), Pfizer (PFE 0.00%↑)
Other articles of interest:
Opinion: What the back-to-school Adderall shortage really tells us - FEE Stories
California Watch: BlueShield of California’s CEO thinks traditional PBMs are on the way out - Becker’s Payer Issues
HIPAA News: Michigan Medicine launches new HIPAA-compliant lab analytics system - Becker’s Health IT
Next week on the FLATLINING Podcast from Fulcrum Strategies, we are having a discussion on who should have a say about what drugs are covered by CMS. Some Republicans are concerned that the FDA is approving drugs and that an administrator at CMS decides shouldn’t be covered by Medicare and Medicaid. Ron and I discuss who makes those coverage decisions and whether it is fair. Subscribe now and never miss and episode:
Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.
We hope everyone has a good, fun, safe long weekend and enjoy the last little bit of summer.
Have a good weekend,
Matthew