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  • Buddy Carter (R-GA), Vern Buchanan (R-FL), and Mike Kelly (R-PA) Offer Bill Extending Access to Short-Term Health Insurance

    Buddy Carter (R-GA), Vern Buchanan (R-FL), and Mike Kelly (R-PA) Offer Bill Extending Access to Short-Term Health Insurance

    U.S. Reps. Buddy Carter (R-GA), Vern Buchanan (R-FL), and Mike Kelly (R-PA) have introduced legislation that would reinstate individuals access to short-term, limited-duration insurance (STLDI) plans, which offer Americans affordable, temporary health coverage options, according to the Ripon Advocate.

    The Healthcare Freedom and Choice Act, H.R. 379, which it is called, would reinstate access to STLDI plans for up to 36 months which represents a significant extension from the four months that was instituted last year via the Biden Administration.

    “Limiting Americans’ access to health care is never good policy, particularly during a cost-of-living crisis,” Rep. Carter said. “I’m proud to lead this effort ensuring that health care is accessible and available to all patients in need and will continue working hand-in-hand with the incoming Trump administration to make America healthy again.”

    “Americans deserve to have more options on the table that are affordable for them and their families,” Rep. Buchanan said. “I look forward to working with Congressman Carter and the incoming Trump administration to rescind this and other ill-advised Biden administration healthcare policies to ensure that Americans can make personal decisions about their own health care.”

    “Lawmakers should work to make health care more affordable for Americans, not more expensive,” Rep. Kelly stated. “This legislation would expand health care freedom and reverse this problematic and costly Biden administration measure.”

  • RefleXion Launches Pivotal Study to Expand SCINTIX Therapy, Expand Medicare Reimbursement

    RefleXion Launches Pivotal Study to Expand SCINTIX Therapy, Expand Medicare Reimbursement

    External-beam theranostic oncology company RefleXion Medical has officially announced the launch of the BIOGUIDE-X2 clinical study to expand indications for SCINTIX® biology-guided radiotherapy at Hackensack Meridian John Theurer Cancer Center.

    Additionally, the company shared updates from the Centers for Medicare and Medicaid (CMS) Services and starting this year CMS will provide broader reimbursement for SCINTIX therapy, including new codes for freestanding cancer centers (FSC) and professional reimbursement for physicians in FSC and hospital outpatient departments.

    “The achievement of these milestones sets the stage for substantial expansion in both the indications for and access to SCINTIX therapy,” Sean Shirvani, M.D., M.P.H., chief medical officer at RefleXion said via the press release. “Given that 40% of American cancer patients receive radiation therapy in freestanding centers1, securing reimbursement for these facilities was imperative, as it eliminates payment barriers for providers adopting new technologies and grants patients access to innovative treatment options.”

    Per the statement, the Medicare updates simplify and expand reimbursement, allowing approximately 400,000 additional patients,2 including those suffering from metastatic disease, access to SCINTIX therapy and also provide support to physicians by introducing a professional payment coding mechanism as part of an effort to assist in the widespread adoption of the tech.

    “We are also buoyed by the initiation of the BIOGUIDE-X2 clinical study, designed as a multi-cohort study for patients with cancers in the liver and abdomen as the first cohorts. We are grateful to our clinical champions at all our sites for their assistance in designing and implementing this study,” Shirvani added.

  • Medicare Prescription Drug Cap Now in Effect

    Medicare Prescription Drug Cap Now in Effect

    A brand new Medicare cap went into effect on January 1st, 2025 and caps prescription drugs at $2,000 a year for enrollees , a drop for the 2024 cap number and representative of some big savings for seniors.

    Since President Joe Biden signed the Inflation Reduction Act into law in 2022 there has been a yearly dig in the price cap, with this year providing another drop in costs as it aims to address drug cost issues for seniors and other Americans as well.

    “As a result, 19 million people are expected to save an average of $400 each,” Biden said earlier this month regarding the bill, via an official statement. “My Inflation Reduction Act has changed Medicare for the better, and as a result Americans will have more money back in their pockets in the years to come.”

    It’s important to note that the new $2,000 out-of-pocket cap on prescription drugs covers everyone with a Medicare Part D plan, the section of Medicare that covers most pharmaceutical products, and also includes people with drug plans through Medicare Advantage, which are offered by private insurers.

    According to CBS News, the cap includes all the prescriptions that are in a Medicare recipient’s Plan D formulary, or a plan’s list of covered drugs, so if a drug is not under that list of covered drugs, it will not be covered by the cap.

  • Sen. Cotton, ABC News’ Jonathan Karl Clash Over Kamala Harris’ Medicare-for-all

    Sen. Cotton, ABC News’ Jonathan Karl Clash Over Kamala Harris’ Medicare-for-all

    Sen. Tom Cotton, R-Ark., got into a verbal sparring match with ABC News’ Jonathan Karl after he dismissed Vice President Kamala Harris’ past commitment in abolishing private health insurance during an on-air exchange that aired on Sunday on ABC’s “This Week.”

    Cotton pushed against Harris for her support for  policies “like supporting decriminalizing immigration, or giving taxpayer funded health insurance to illegal aliens” and argued that former President Trump, who is running against her, will work to draw a “sharp contrast” from her platform during the leadup to this year’s Presidential Election.

    Cotton than brought up Harris’ prior support for “taking away health insurance on the job for 170 million Americans” which saw the conversation take a noticeable turn.

    “What do you mean taking away health insurance? What are you talking about?” Karl pressed as Cotton continued to press far-left issues that the Harris campaign had previously embraced, via Yahoo News.

    Cotton reminded Karl that Harris had supported eliminating private health insurance as part of her “Medicare-for-all” push during her 2019 presidential campaign.

    “I mean, that is not her position now,” Karl said in response saying that Harris said she no longer supports “Medicare-for-all.”

    “How do you know that is not her position now?” Cotton pushed. “She has not said that. Maybe anonymous aides on a Friday night have said that, but the last thing that she said…” he continued before Karl again interjected.

    Karl would later praise Harris for for “making an effort to move to the middle” of her party.

    “She’s taking these efforts not to change these positions but to hide these positions,” Cotton jousted. “The American people are totally justified to conclude that Kamala Harris is a dangerous San Francisco liberal based on what she campaigned on the last time she ran for president and what this administration has done the last four years.

    “You would’ve thought watching the DNC last week that the Democrats are not in office, they’re not in power, that they’re campaigning against an incumbent Republican, when in reality, she’s been part of the failures of the Biden-Harris administration for four years and when she campaigned for president in her own right, she did in fact promised things…”

    The two than had a tense back-and-forth over Harris’ positions on issues in the past, and presently during her run for President.

    Now, others in the media are calling out Karl, and others in the media circle, for not pressing Harris on her different positions and her efforts to avoid engaging on the topic during press engagements and in interviews.

    “For the sake of argument let’s say she has changed her position. Jon Karl and the rest of the corporate press seem totally uninterested in WHY she suddenly changed all these positions she campaigned on in 2020, and they will never ask her about it,” The Federalist’s senior editor John Daniel Davidson wrote.

  • Oregon State Hospital Deficiencies Threaten Medicare Status

    Oregon State Hospital Deficiencies Threaten Medicare Status

    Deficiencies at the Oregon State Hospital that were communicated in a statement from the Centers for Medicare and Medicaid Services following a survey conducted after a patient death in May of this year could put the hospital’s Medicare agreement at risk, according to the Statesman Journal.

    The aforementioned survey found that there were deficiencies related to continuous rounds and viability checks, patient monitoring, screening of visitors, supervision of patient visits with family and friends, and quality of incident investigation and response.

    Now, the Oregon State Hospital has 10 calendar days, until September 2nd, to formally respond and include their plan for correcting the issues.

    Once that plan is approved, the Centers for Medicare and Medicaid Services will conduct an additional survey to review the implementation and changes.

    Furthermore, the Oregon State Hospital has up until October 24th to correct all of their deficiencies and receive approval from CMS, and failure to do so will lead to the termination of the hospital’s Medicare agreement and will cease making payments for patient services.

    “We have been entrusted with the care of some of Oregon’s most vulnerable residents. Their safety and well-being are our top priority,” interim Superintendent and Chief Medical Officer Sara Walker said in an official press release issued on Monday. “We will continue to make the changes necessary to protect our patients.”

    The Oregon State Hospital has been under scrutiny over the last few years due to a number of issues, including disorganization, that has found them in a heap of hot water following the death of a patient.

  • Study Shows That Medicare Coverage of Novo’s Semaglutide for CVD Could Cost $145 Billion Per Year

    Study Shows That Medicare Coverage of Novo’s Semaglutide for CVD Could Cost $145 Billion Per Year

    A new study is showing that providing Part D Medicare coverage for Novo Nordisk’s semaglutide to reduce cardiovascular disease risk in certain patients could cost the United States Government around $145 billion annually, according to new research published Tuesday in the Annals of Internal Medicine.

    Semaglutide, which is branded as Ozempic for type 2 diabetes and Wegovy for chronic weight management, is a blockbuster GLP-1 receptor agonist that promotes insulin secretion from the pancreas and helps suppress appetite.

    As of now, the Centers for Medicare and Medicaid Services (CMS) covers the therapy for diabetes but have not yet approved coverage for anti-obesity usage.

    Back in November 2023, data from the Phase III SELECT study showed that a 2.4-mg Wegovy dose could significantly reduce the risk of major adverse cardiovascular events by 20% versus placebo and patients that were reated with Wegovy also saw a 28% lower risk of heart attack or myocardial infarction.

    These findings led the FDA to expand Wegovy’s approval back in March of this year (2024) and allowed it’s use to decrease the likelihood of cardiovascular death, heart attack and/or stroke in overweight and obese adults with cardiovascular disease (CVD), and the CMS later announced that it would cover Wegovy for this use,  for patients with body mass index of at least 27 kg/m2.

    The new study found that around 3.6 million adults would be eligible for semaglutide coverage under CMS’ new guidelines. which would balloon coverage to 15.2 million adults, which could see Medicare expenditures jump by $34 billion to $145 billion if all of these new beneficiaries used semaglutide, research showed.

    CBO’s analysts wrote that anti-obesity medications such as semaglutide “would cost the federal government more than it would save from reducing other healthcare spending,” leading to an “overall increase in the deficit over the next 10 years.”

    Additionally, CBO has also predicted hat semaglutide would most likely be selected for Medicare drug price negotiations “within the next few years.”

  • Medicare Reimbursement For Breast Surgery Showing Steady Decline

    Medicare Reimbursement For Breast Surgery Showing Steady Decline

    Breast surgery is no long and exception in regards to Medicare reimbursement rates according to new research, via General Surgery News.

    Breast reduction surgery, which is also known as reduction mammaplasty, involves removing skin and tissue from the breasts, then reshaping them to a smaller size, a surgery that has been on the rise since the pandemic as those surgeries that were not considered medically necessary and were paid for out of pocket increased by 54% from 2019 to 2022, according to the American Society of Plastic Surgeons (ASPS).

    In the past, in order to obtain coverage for breast reduction surgery through Medicare or Medicare Advantage, the procedure needs to be medically necessary, and not to be done simply for cosmetic.

    Additionally, it needs to meet the following criteria.

    • To reduce decrease or eliminate symptoms caused by breast size
    • To reduce the size of a breast to make it symmetrical with a breast reconstructed after breast cancer surgery

    The Centers for Medicare & Medicaid Services (CMS) have outlined the following as well:

    • Surgeons must make sure that patients have tried non-surgical interventions to alleviate breast pain or chafing, such as chiropractic care, physical therapy, and dermatologic treatments
    • The symptom(s) must have been present for a minimum of six months
    • Interventions and medical treatment were not able to alleviate symptoms adequately
    • The patient has been notified of the risks of complications
    • The notes indicate the proposed amount of tissue to be removed and the rationale supporting that determination

    But a new report shows data that suggests medicare reimbursement for breast surgery is showing a steady decline, and the impact on the folks who need the surgery and the plastic surgeons who provide it is being felt.

    Read the article for more information.

  • Vice President Kamala Harris No Longer Pushing Medicare for All

    Vice President Kamala Harris No Longer Pushing Medicare for All

    Vice President Kamala Harris is reportedly no longer pushing “Medicare for All” during her campaign aft Harris co-sponsored Sen. Bernie Sanders’ Medicare for All legislation when she was a California senator and offered a modified plan as the centerpiece of her bid for President back in 2020, according to Politico.

    Harris is shifting to the center of her party, aligning with some of their stances, and progressives reportedly are disappointed but still support her as she vies to defeat former President Donald Trump in this year’s election.

    “When you juxtapose the possibility of disappointment with the possibility of a loss of democracy, I think that I would choose a health policy that doesn’t exactly fit my desires every time,” Gillian Mason, interim executive director at Healthcare-NOW said, per the report.

    “The votes just aren’t there for Medicare for All,” Larry Levitt, executive vice president of health policy at the nonpartisan health institute KFF added.

    “Of course I would like anybody running for president to say that they want Medicare for All,” Dr. Ed Weisbart, national board secretary of Physicians for a National Health Program said.

  • Court Says Medicare Recovery Actions Can’t be Made by Uninjured Parties

    Court Says Medicare Recovery Actions Can’t be Made by Uninjured Parties

    Medicare reimbursements from insurance companies has been a big winner for the legal industry over the last decade or so, but a federal appeals court decision this week may have an impact on the trend.

    In a class-action case that has been in the public eye around the United States,  the 4th U.S. Circuit Court of Appeals has said that the lead plaintiff, a widow of a deceased North Carolina UPS worker, has no legal standing to sue Liberty Mutual Insurance companies because she wasn’t really injured and had not lost any money, in a decision made on Monday.

    “No matter what right or cause of action a statute may grant a plaintiff, she must still have an injury in fact to sue in federal court,” a panel of 4th Circuit judges said (h/t Insurance Journal). The panel referenced a 2016 court ruling in the process.

    “Congress may elevate harms that were previously insufficient to justify suit ‘to actionable legal status’ via statutory causes of action,” the court wrote. “But that does not mean that Congress can override Article III and expand federal court jurisdiction beyond its constitutional confines.”

    Ultimately, the federal district court agreed with Liberty Mutual and dismissed the case.

    “Since Liberty Mutual was not obligated to pay Penegar the funds owed to Medicare, the failure to pay did not injure her like it did the plaintiff in Netro,” the 4th Circuit opinion states.

    You can read the entire ruling here.

  • Medicare Recipients Can Join Amazon’s RxPass for $5 Monthly

    Medicare Recipients Can Join Amazon’s RxPass for $5 Monthly

    Amazon Pharmacy’s medication subscription service Amazon RxPass is now available for just $5 per month for current Medicare enrollees which could potentially offer some much needed savings, according to Consumer Affairs.

    “There are a high number of adults who, whether due to cost, mobility, or simply not having time to collect their medications from the pharmacy, are not adhering to a medication regimen that could be life-saving,” Dr. Vin Gupta, chief medical officer of Amazon Pharmacy and a practicing pulmonologist said, via the report.

    “When a patient’s medication arrives regularly at their door, at a price they can afford, we see better long-term health outcomes.”

    RxPass offers members the ability to have their prescriptions delivered right to their door, at no charge, which eliminates the waiting lines at pharmacies or the worry about running out of medications, in some cases.

    Additionally, the RxPass membership includes the ability for members to speak with a pharmacist 24/7 should they have any questions.

    You must be a member of Amazon Prime to join, and it’s important to keep in mind that RxPass offerings may not include medications that you require, and although RxPass offers generic prescriptions that cover more than 75 common health conditions like anxiety, high blood pressure, and acid reflux, not every drug is available through them.

    According to Consumer Affairs, this is what Rx Pass does and doesn’t have.

    MEDICATION AVAILABLE WITH AMAZON Rx PASS
    Simvastatin No
    Lisinopril Yes
    Levothyroxine No
    Amlodipine Besylate No
    Omeprazole Yes
    Azithromycin No
    Metformin No
    Hydrochlorothiazide No
    Hydrocodone No