Medicaid Expansion Coverage Begins
On Thursday, July 1, over 120,000 Oklahomans gained coverage through Medicaid expansion. U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra and Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure visited Tulsa and met with Cherokee National leaders this week to celebrate coverage taking effect. Oklahoma is now the 37th state, plus D.C., to implement Medicaid expansion, and the fifth to expand it at the ballot box.
OKPCA is partnering with Steve Goldman, a Navigator with expertise in health center outreach and enrollment, to help health center certified application counselors (CACs), community health workers, and other enrollment staff enroll patients eligible for Medicaid expansion. Workshops will provide a combination of training on Medicaid and Marketplace enrollment assistance as well as a place for enrollment teams to ask questions and share best practices.
Upcoming workshops will be held Thursdays at 1:00 PM on July 8, 15, 22; and August 5, 19. Webinars will be recorded and materials will be posted on the
Outreach and Enrollment Community on OKPCA's member portal.
Learn more and register now.
Medicaid Managed Care Contracts Terminated
At Wednesday's board meeting, Oklahoma Health Care Authority (OHCA) CEO and
Secretary of Health and Mental Health for the State Kevin Corbett confirmed that the contracts the agency entered into with third-party vendors to oversee and implement its transition to a third-party managed care system had been terminated due to the last month's Supreme Court decision.
"We have had conversations with the governor's office as to the direction we would pursue following that ruling. I can tell you at this point in time, there's no decision that has been made," Corbett told the audience. "What we plan to do is continue to serve our members, including the expansion population, as we do today."
340B Updates
- Submit Comments on 340B Insulin & EpiPen Rule
- Health centers are strongly encouraged to submit comments supporting BPHC’s proposal to rescind the regulation on insulin and EpiPen pricing. A short template and long template are available.The comment deadline is Friday, July 16.
- PROTECT 340B Act
- Today, the PROTECT 340B Act was introduced in the U.S. House by Rep. Abigail Spanberger (D-VA) and Rep. David McKinley (R-WV). The bill would generally prohibit health insurers and Pharmaceutical Benefits Managers (PBMs) from discriminating against 340B providers or their contract pharmacies by imposing different rules or reimbursement terms than imposed on other providers or pharmacies. It also prohibits manufacturers and PBMs from treating 340B providers and their contract pharmacies differently from other similarly-situated providers and pharmacies with regards to reimbursement, fees, participation, and audits. It further Instructs HHS to contract with a neutral third party to serve as a clearinghouse for data needed to prevent duplicate discounts under Medicaid. The contractor would collect data on 340B drugs reimbursed by Medicaid and ensure that those drugs are not included in States’ Medicaid rebate requests.
- Unfavorable Court Rulings
- Two developments this week are raising concerns about the long-term success of current legal efforts to force drug manufacturers to resume shipping 340B-priced drugs to contract pharmacies:On Wednesday, a federal judge in Delaware issued a procedural decision that some legal experts interpret as suggesting that he will rule in favor of drug maker Astra-Zeneca's case that claimed HRSA’s contract pharmacy policy is “arbitrary and capricious.” Also on Wednesday, a seventh drug maker (Boehringer Ingelheim) announced it will stop shipping 340B-purchased drugs to hospitals’ contract pharmacies, effective August 1. BI’s policy is limited to hospitals and exempts all “grantees” including health centers. Nonetheless, this suggests that drug manufacturers are feeling emboldened to expand contract pharmacy restrictions, despite the on-going litigation and the written warnings that HHS sent to drug makers in May.
- Express Scripts (ESI) Requests
- Health centers are not required to respond to letters from Express Scripts (ESI) inquiring about certain 340B claims, but many may consider it worthwhile. The only time health centers must provide data about a drug’s 340B status is when the drug was reimbursed under Medicaid, and that data should only be shared with the State Medicaid agency or its agent.) However, some health centers are still choosing to reply, because they are currently out of compliance with ESI’s requirement to include a modifier on all 340B claims, and do not want to draw attention to themselves within ESI. Also, the quantity of claims data requested is very small compared to groups such as Kalderos and CiiTA.