Monday Morning Medicaid Must Reads: September 17th, 2018

Helping you consider differing viewpoints. Before it’s illegal. 


Article 1:  

NC Medicaid guidelines limit what drugs doctors can use to fight opioid addiction, Nick Oshner, WBTV3, August 30th, 2018

Clay’s summary: Generic vs brand becomes an issue in the opioid crisis.

Key Passage from the Article

In North Carolina, doctors must prescribe either Suboxone or Sublocade to treat opioid addiction in new patients who are using Medicaid insurance. The requirements are listed on the state’s Medicaid formulary, which sets out preferred drugs and non-preferred drugs. Under the formulary for drugs to treat opioid addiction, doctors must first prescribe Suboxone or Sublocade before trying any other generic or pill form of the drug. But, doctors like Manos say there is no medical difference between the name brand drugs and the generic alternatives.

“If you have the active ingredient of buprenorphine in a product and it’s FDA regulated, then the generic is the equivalent to the name brand,” Manos explained.

The only real difference in the name brand and generic versions is price. Manos said the generic alternatives to Suboxone and Sublocation could be one-third to one-fourth of the cost of the name brand drug without rebates. “Does that tie your hands as a physician?” a WBTV reporter asked Manos of the requirement to prescribe only the name brand sublingual strip or injectable. “Well, of course, if they’re saying that you must use what’s on the formulary,” Manos said. “It’s just the way of medicine today.”

But the head of North Carolina’s Medicaid takes a different view. Dave Richard, Deputy Secretary for North Carolina Department of Health and Human Services, said the limits imposed by the state’s formulary is the best for patients and for taxpayers who fund the Medicaid program. Specifically, Richard told WBTV, the state uses a preferred drug list that is administered by the federal government that gives the state rebates on certain drugs. In the case of drugs that treat opioid addiction, the state gets a rebate on name brand drugs manufactured by Indivior. “Through the rebate process, we try to get the best deal for North Carolina for those drugs, which are appropriate for the use of the individuals,” Richard said…



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Article 2:   

The Man Who Used To Run Medicaid Has A New Idea To Make It Better, Michela Tindera, Forbes, August 22, 2018

Clay’s summary: Wonder Andy he can do for these startups what he did for Optum?

Key Passage from the Article

Slavitt is back in the private sector and again focused on fixing America’s healthcare system, this time from outside the government. In the past year he’s founded and launched both a nonprofit (United States of Care) and a venture capital firm (Town Hall Ventures). Next up? The Medicaid Transformation Project, a plan to improve the way the 75 million Americans on Medicaid receive treatment at some of the country’s largest hospital systems. “When I left CMS, I launched an initiative in three critical areas to basically say, we want to change the way healthcare works in a decade,” says Slavitt. “I was 50 when I left. The question I ask myself is by the time I’m 60, what do I want to be different?” Slavitt is pulling together the CEOs of 17 hospital systems around the country to commit to improving care for their Medicaid patients over the next two years in at least four areas: behavioral health, women and infant care, substance use disorder as well as aiming to reduce the number of preventable emergency department visits. The participating hospital systems serve over half of the country’s Medicaid population across 21 states…


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Article 3:   

Medicaid Administrator Verma Blames Ballooning Costs on Structural Problems, Holly Kellum, The Epoch Times, August 24, 2018

Correcting an injustice: HHS moves to stop unions from skimming from Medicaid, Chantal Lovell  & Vincent Vernuccio, Washington Examiner,  August 07, 2018

Clay’s summary: You don’t say.

Key Passage from the Article

For “expansion” states, the federal government agreed to cover 100 percent of newly eligible patient costs from 2014 through 2016. In 2017, it agreed to cover 95 percent of their costs, and this year, will cover 94 percent. The match rate will decline to 90 percent starting in 2020, where it will remain indefinitely. There is no limit on how many people can enroll, so the government, both state and federal, will be left to pick up the tab, no matter how large. Verma said these new enrollees alone are estimated to cost the government $806 billion between 2016 and 2025. “I think that diverts the program from the most vulnerable populations,” she said. “We’ve always had program integrity efforts with the Medicaid program. Given the change with the match rate, and it’s not only the 90 percent, but it’s a completely open-ended entitlement, the incentives aren’t necessarily in place for states to focus on program integrity.” She said it’s also possible that states are taking advantage of this higher match rate. The federal government pays at least 50 percent of the cost for traditional Medicaid patients, but with a minimum 90 percent match rate for “expansion” enrollees, she said this creates an incentive for states to shift traditional Medicaid patients into the “expansion” population…


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