As we noted in July, CMS declined Massachusetts’ Medicaid 1115 demonstration request to establish a closed formulary.  The proposed program would have given Massachusetts the ability to exclude certain FDA-approved drugs from coverage and thereby given the state additional leverage in negotiating rebates.  The state and drug manufacturers would have otherwise continued to be subject […]

As the United States continues to move toward a value-based health care system, significant challenges slow down our progress. Political pressure exists from all sides, incentives have yet to be appropriately aligned, and the pressing need to change stakeholder behavior remains a time-sensitive imperative. Solving these challenges requires going beyond admiring the challenges to implementing […]

For the second year in a row, Leavitt Partners presented on diabetes prevention at the Office of Personnel Management (OPM) annual carrier conference. The presentation was made on behalf of the National Association of Chronic Disease Directors (NACDD) and alongside the Centers for Disease Control and Prevention (CDC) Division of Diabetes Translation (DDT). OPM’s Federal […]

The latest information from the Centers for Medicare & Medicaid Services (CMS)[1] on the number of plan selections for the current Open Enrollment Period (EOP) has been a positive sign for stakeholders that are hoping for a large and stable enrollment cycle. While the number of plan selections has been higher than in the previous […]

More than 86 million American adults have prediabetes. That number alone is astounding, but perhaps what is even more concerning is that 9 out of 10 people with prediabetes don’t know they have it. Considering that, in the absence of any health intervention, 15‒30 percent of people with prediabetes will develop type 2 diabetes within five years, effective preventive measures are needed to mitigate a serious public health crisis. The Centers for Disease Control and Prevention (CDC) is proactively responding to this potential problem by developing and promoting the National Diabetes Prevention Program (National DPP) lifestyle change program.

According to the National Institute on Drug Abuse and the CDC, in 2015 over 33,000 people died from opioid overdose in the United States, and in 2013 prescription opioid abuse cost the U.S. economy approximately $78.5 billion in costs related to health care, crime, and loss of productivity. Opioid abuse and the related overdose deaths […]

Given the well-publicized challenges with the individual market, carriers’ product development and pricing process for 2018 has been particularly difficult. In an effort to give insurers some reprieve, last week the Centers for Medicare and Medicaid Services extended the deadline for issuers to make changes to their rate filings from August 16 to September 5.[1]  However, […]

In the U.S., a person’s health status is impacted by a variety of factors such as race/ethnicity, disability status, socioeconomic status, age, gender, sexual orientation, geography, and more. These differences in society are linked to inequalities in health status that are referred to as health care disparities. The CDC defines health disparities as “preventable differences […]