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A closer look at how health care consolidation drives up patient costs, creates barriers to care

PhRMA

Half of every dollar spent on medicines goes to entities that don’t make medicine—like pharmacy benefit managers (PBMs) and insurers who are aggressively consolidating their control over health care and hospitals, clinics and for-profit pharmacies in the 340B markup program.

Insurance 268
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Nonprofit hospitals fall short on community benefit, studies show

PhRMA

Nonprofit hospitals are supposed to help provide access to crucial treatment and services in our most vulnerable communities. But recent research adds to the mountain of evidence showing nonprofit hospitals continue to fall short in their community benefit.

Hospitals 258
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RAND: Hospitals charged insurers 254% more than Medicare rates in 2022

Fierce Healthcare

The gap between insurance plans and Medicare's payments to hospitals for inpatient and outpatient services widened over the course of just a couple of years, a new study from RAND Corporation | A new report from RAND Corporation highlighted just how much more employers and private insurers are paying hospitals for inpatient and outpatient services. (..)

Insurance 134
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STAT+: UnitedHealth cyberattack cripples pharmacies’ and hospitals’ ability to process insurance claims

STAT

Hospitals, pharmacies, and other health care providers are getting stuck in an insurance processing logjam after UnitedHealth Group disclosed a cyberattack within a recently acquired subsidiary that serves as a central hub for payments across the industry.

Insurance 145
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STAT+: UnitedHealth continues making stealthy deals, pushing deeper into medical care as scrutiny mounts

STAT

  The sprawling conglomerate — which owns a major health insurance company, physician practices, a pharmacy benefit manager, and numerous other firms — acquired or created more than 250 subsidiaries in 2024. UnitedHealth Group, the largest health care company in the U.S., has clear ambitions of getting bigger. 

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Why Congress should prioritize fixing the 340B program

PhRMA

These include things like making sure patients aren’t paying more for their medicines than their health insurance company or requiring first-dollar coverage, so insurance companies cover the cost of certain lifesaving medicines from day one of the plan year. These are concrete steps, but they aren’t the only ones Congress could take.

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Hospital-backed proposal would make insurers reveal prior auth denial rates

Fierce Healthcare

A recommendation on the 2024 Measures Under Consideration list, brought forward by the Federation of American Hospitals (FAH), would add a quality measure in the Medicare Advantage (MA) star rating | The Federation of American Hospitals is pushing CMS for the inclusion of a star ratings quality measure that shows how often insurers overturn or uphold (..)

Insurance 128