Gavin Newsom’s health agenda

Today, public and private purchasers of prescription drugs for Medi-Cal, California’s largest purchaser of pharmaceutical services, are fragmented, left to negotiate against drug companies alone. The negotiation for pricing and purchasing of prescription drugs under Medi-Cal will now be conducted by the Department of Health Care Services on behalf of all 13 million Medi-Cal beneficiaries, as opposed to only 2 million currently. Further, the executive order directs state agencies to purchase prescription drugs together, as opposed to negotiating with drug companies one by one; and charts the path to enable all Californians, including private purchasers, to join forces with public purchasers.

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In his budget, Governor Newsom will propose California take another major step toward universal coverage, by extending Medi-Cal eligibility to undocumented young adults who otherwise meet the program’s eligibility requirements.

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His budget proposes increasing the size of the subsidies for families who already receive it, and it would make California the first state to make subsidies available to middle income families.

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California will be the first state in the nation to offer subsidies to individuals and families with income between 400 and 600 percent of the federal poverty level.

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Governor Newsom sent a letter today to President Trump and Congressional leaders calling on the federal government to lift these limitations and, instead, empower states like California to enact transformative change that would allow California to develop a single-payer health system to achieve universal coverage, contain costs, and promote quality and affordability

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Governor Newsom signed an executive order to establish a California Surgeon General, who will lead all Californians in addressing the root causes of serious health conditions, such as adverse childhood experiences and the social determinants of health.

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Greenbeard said:

Newsom strikes quickly, with his first actions out of the gate--dashing off a couple of executive orders, laying out budget proposals, and engaging in federal advocacy--dedicated to advancing his health care agenda.

Here's the agenda he pushed earlier today:

1. Creating the largest-scale single-purchaser system for prescription drugs



2. Making California the first state to cover undocumented young adults through Medi-Cal


3. Expanding Obamacare financial help for families & reinforcing the Affordable Care Act after federal attacks



4. Calls on the federal government to empower California to truly innovate


5. Establishing the California Surgeon General to focus on root causes

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Greenbeard said:

Newsom strikes quickly, with his first actions out of the gate--dashing off a couple of executive orders, laying out budget proposals, and engaging in federal advocacy--dedicated to advancing his health care agenda.

Here's the agenda he pushed earlier today:

1. Creating the largest-scale single-purchaser system for prescription drugs

Click to expand...

Greenbeard said:

3. Expanding Obamacare financial help for families & reinforcing the Affordable Care Act after federal attacks

California will be the first state in the nation to offer subsidies to individuals and families with income between 400 and 600 percent of the federal poverty level.

Click to expand...

Greenbeard said:

Newsom strikes quickly, with his first actions out of the gate--dashing off a couple of executive orders, laying out budget proposals, and engaging in federal advocacy--dedicated to advancing his health care agenda.

Here's the agenda he pushed earlier today:

1. Creating the largest-scale single-purchaser system for prescription drugs



2. Making California the first state to cover undocumented young adults through Medi-Cal


3. Expanding Obamacare financial help for families & reinforcing the Affordable Care Act after federal attacks



4. Calls on the federal government to empower California to truly innovate


5. Establishing the California Surgeon General to focus on root causes

Click to expand...

Gov. Gavin Newson wants to deliver lower drug prices by harnessing the full weight of the state against the pharmaceutical industry, but it’s unclear whether his team can get a better deal without giving up something Californians want.

In his first act as governor, Newsom issued an executive order creating the largest single purchaser of prescription drugs in the country.

It combines negotiations for some 13 million people in government-administered plans like Medi-Cal and eventually invites other organizations to join. His argument centers on the idea that a bigger organization can extract a better price from pharmaceutical companies.

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Health policy experts said there’s no guarantee the ambitious plan will work.

Size has its limits, experts said, and the downside could be Californians losing access to certain drugs.

“To some extent, scale counts. (But) I am skeptical that just aggregating by itself gives much more bargaining leverage,” said James Robinson, who directs the UC Berkeley Center for Health Technology.

“At the end of the day, what gives bargaining leverage for a purchaser is you say ‘if you don’t give me a discount I will not buy your product,’” he said.

That means getting better prices could put politicians in the position of denying certain pricey drugs to beneficiaries, Robinson said.

Jennifer Kent, director of the California Department of Health Care Services, says federal protections ensure that necessary drugs will be covered. Federal law requires that Medi-Cal cover drugs that a doctor says a patient needs, and that won’t change under Newsom’s executive order, she said.

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A 2013 report by the California Health Foundation concluded the state already possesses considerable market power. Since 1995 at least 14 states, including Massachusetts, New York and Georgia have tried to coordinate drug purchasing through block negotiations, the report said.

The Assembly recently commissioned a study on health care options from a group of University of California researchers. It concluded states have had trouble creating and sustaining such large negotiating agencies.

“The real flaw here I think is an understanding flaw that just bigger means being able to negotiate more,” said Ian Spatz, a senior adviser with the law firm Manatt, Phelps & Phillips and an adjunct professor at the University of Southern California. “In the drug world, the better prices have come from your ability to favor one drug over another by using formularies.”

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Greenbeard said:

A closer look at item #1 today:

Gavin Newsom made a big move on drug pricing. Will it save you money?





In other words, scale without the ability to say 'no' doesn't necessarily mean much. To that end, last year Massachusetts asked the federal government for permission to implement a closed formulary in its Medicaid program, allowing it to be more choosy about which drugs it covers in a bid to provide it more negotiating leverage and thereby hold down costs: Massachusetts' Medicaid Proposal Could Be a Model for the U.S..

That request was not approved: CMS denies Massachusetts' request to choose which drugs Medicaid covers.

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enderpotato00 said:

I love it when out-of-staters think they know what's going on in California....

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