Drug Topics

JUNE 21, 2023

Antiobesity medications are considered to be 'vanity drugs' by many private insurers, and the refusal to cover obesity treatment is counterproductive because of obesity's many health consequences.

Insurance Coverage 183

Insurance Coverage Insurance 183

Drug Topics

APRIL 11, 2024

Joe McKamey, general manager at Marcrom’s Pharmacy, highlights the potential pitfalls or misconceptions that pharmacies may encounter when opening a Medicare-focused insurance agency.

Insurance 154

Insurance 154

PhRMA

NOVEMBER 16, 2022

There is only one place in the health care system where middlemen refuse to share negotiated prices with patients, and that’s at the pharmacy counter. A new report reveals how this harmful tactic leads to higher costs for patients.

Insurance 298

Insurance 298

STAT

SEPTEMBER 9, 2024

The Biden administration on Monday announced it would finalize a highly anticipated proposal meant to force health insurers to cover mental health care on the same basis as physical health conditions. 

Insurance 145

Insurance 145

STAT

MAY 29, 2024

Health insurers are telling shareholders that they are ramping up the use of artificial intelligence and are hiring talent to implement the technology across their organizations. However, all five of the insurers STAT contacted declined to elaborate on how they are using AI. Continue to STAT+ to read the full story…

Insurance 145

Insurance 145

STAT

OCTOBER 4, 2024

Health insurance companies will still offer older adults a lot of plan choices with low, or completely free, premiums. However, insurers have made important but subtle tweaks to next year’s plans that will force millions of members to shell out more for their prescription drugs and overall medical care than they do currently.

Insurance 139

Insurance Health Insurance Companies 139

STAT

SEPTEMBER 13, 2024

For years, health insurers battled to gain market share in the lucrative privatized Medicare program. When insurers release their 2025 plan offerings on Oct. Now, the opposite is true. Some of the companies say they designed their 2025 plans with an eye toward ditching members.  1, there likely will be fewer choices and freebies. 

Insurance 138

Insurance 138

Drug Topics

APRIL 6, 2024

Joe McKamey, general manager at Marcrom’s Pharmacy in Manchester, Tennessee, talks about why pharmacies should open their own Medicare-focused insurance agency and what steps and preparations they can take to ensure a successful launch and operation.

Independent Pharmacies 144

Independent Pharmacies Insurance 144

STAT

FEBRUARY 23, 2024

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

Insurance Hospitals Insurance Processing 145

Fierce Healthcare

MAY 13, 2024

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

Insurance Hospitals 134

STAT

OCTOBER 24, 2024

A federal watchdog found that Medicare Advantage insurers collected billions of dollars in dubious payments from Medicare in a single year by using home visits and medical chart reviews to diagnose patients with conditions for which they received no follow-up care.   

Insurance 145

Insurance Medical Records 145

STAT

APRIL 9, 2024

One of the country’s biggest life insurers is venturing into genetic testing, an area that’s historically been a minefield for that industry, in a purported effort to keep its members alive longer.    MassMutual announced Tuesday that it’s offering many of its 4.2 The Springfield, Mass.-based

Insurance 145

Insurance 145

STAT

OCTOBER 17, 2024

The nation’s three largest Medicare Advantage insurers increasingly refused to pay for rehabilitative care for seniors in the years after adopting sophisticated technologies to aid in their coverage decisions, a Senate investigation found. The report, conducted by the U.S.

Insurance 145

Insurance Nursing Homes Hospitals 145

STAT

OCTOBER 21, 2024

Does it make sense for a chain of drug stores to own a major health insurance company? That has been the existential question for CVS Health for six years, since its $70 billion acquisition of the massive insurer Aetna. The biggest pharmacy chain in the U.S.   Continue to STAT+ to read the full story…

Insurance 132

Insurance Health Insurance Companies 132

Fierce Healthcare

SEPTEMBER 26, 2024

State laws mandate insurers cover a 12-month supply of contraception but this requirement is rarely followed by insurers, a JAMA Health Forum study reviewing Medicaid plans in nearly a dozen states | Insurance plans are supposed to cover a 12-month supply of birth control pills, but a recent study found that requirement is rarely followed.

Insurance 122

Insurance 122

STAT

DECEMBER 12, 2024

Companies use AI to fight insurance denials People infrequently challenge health insurance denials even though appeals are often successful. You’re reading the web edition of STAT’s Health Tech newsletter, our guide to how technology is transforming the life sciences. 

Insurance 108

Insurance 108

Fierce Healthcare

SEPTEMBER 19, 2024

Major Indiana managed care organizations and health systems are blamed for defrauding the state Medicaid system by tens, if not hundreds, of millions of dollars, says a newly unsealed whistleblower | A newly unsealed lawsuit alleges major health insurers and health systems defrauded Indiana Medicaid by hundreds of millions of dollars, with the government (..)

Insurance 137

Insurance Hospitals 137

STAT

JULY 17, 2024

Wall Street’s reaction was swift Wednesday after Elevance Health said that the amount of care its Medicaid members are getting is outpacing what states are paying the insurer to treat those members.

Insurance 132

Insurance 132

Drug Topics

APRIL 19, 2024

A Q&A with Joe McKamey, general manager at Marcrom’s Pharmacy in Manchester, Tennessee.

Independent Pharmacies 201

Independent Pharmacies Insurance 201

PhRMA

FEBRUARY 16, 2023

Did you know that insurance companies use middlemen — known as pharmacy benefit managers (PBMs) — to decide what medicines people can get and what people pay out of pocket for those medicines?

Insurance 298

Insurance 298

Pharmacy Times

SEPTEMBER 3, 2024

Patients with DLBCL on Medicaid had worse survival outcomes than those on commercial insurance, but there were no statistically significant differences in survival between races.

Insurance 132

Insurance 132

STAT

MAY 16, 2024

Limited access stems from three main issues: the discontinuation of a common branded asthma medication, lack of insurance coverage for its generic alternative, and shortages of a similar branded alternative. This increase in child asthma acuity and deaths is likely multifactorial, but access to basic medications is one modifiable driver.

Insurance 144

Insurance Insurance Coverage 144

PhRMA

SEPTEMBER 12, 2022

Administrative hurdles and other barriers imposed by health insurers and pharmacy benefit managers (PBMs), such as time-consuming paperwork or prior authorization, are a challenge for many insured Americans, including more vulnerable communities.

Insurance 264

Insurance 264

PhRMA

OCTOBER 5, 2022

Insurer-imposed barriers like high deductibles and coinsurance shift the cost of life-saving care onto patients. Manufacturers and others have stepped forward to assist patients who face high out-of-pocket costs, using programs like copay coupons to help eligible, commercially insured patients afford their out-of-pocket costs.

Insurance 263

Insurance 263

PhRMA

MARCH 2, 2023

Health plans are increasingly using deductibles and coinsurance to shift more of the cost of care to chronically ill patients taking brand medicines.

Insurance 243

Insurance 243

Fierce Healthcare

SEPTEMBER 25, 2024

Startup Medicare Advantage insurer Zing Health banked a $140 million funding round it intends to use to enhance its special needs plans. Startup Medicare Advantage insurer Zing Health banked a $140 million funding round it intends to use to enhance its special needs plans.

Insurance 118

Insurance 118

Drug Topics

FEBRUARY 15, 2024

Innovation in the vaccine area continues. In 2023, the FDA approved six vaccines, including several important firsts. But they face a difficult landscape where federal policies dictate coverage.

Vaccines 184

Vaccines Insurance FDA 184

Fierce Healthcare

NOVEMBER 5, 2024

Yet another major insurer is taking the federal government to court over all-important star ratings results. Elevance Health is hitting back at CMS star ratings over statistical variation and inability of replication in the latest lawsuit to face the feds.

Insurance 114

Insurance 114

Fierce Healthcare

AUGUST 14, 2024

Evidence points to overconsumption of ultra-processed foods leading to severe health outcomes, but food is medicine interventions with insurers rarely set out to directly restrict or limit these foods from their members' diets. Cognitive impairment.

Insurance 126

Insurance 126

PhRMA

JUNE 2, 2023

With Congress discussing policy changes that would lower drug costs for patients and rein in powerful middlemen, insurers and their PBMs are dusting off their old playbook and once again threatening to increase costs for employers if required to do their job and actually provide meaningful coverage to patients.

Insurance 306

Insurance 306

STAT

OCTOBER 17, 2024

People who rely on Medicaid continue to get medical care at high rates, and it’s presenting a growing challenge for the major health insurers who cover them. 

Insurance 108

Insurance 108

STAT

SEPTEMBER 17, 2024

The comments, especially from the large pharmaceutical companies and insurers, underscore how Medicare’s decisions could help define how the health care system pays for emerging technologies.

Insurance 134

Insurance Pharmaceutical Companies Pharmaceutical Companies 134

STAT

DECEMBER 11, 2024

A proposed Senate bill that would prohibit companies that control health insurers or pharmacy benefit managers from owning pharmacies rattled investors on Wednesday, but some Wall Street analysts believe the legislation is unlikely to gain much traction, at least for now.

Insurance 132

Insurance Independent Pharmacies 132

PhRMA

MAY 8, 2023

This new law will ensure that Indiana patients aren’t paying more for their medicines than their health insurance company or the middlemen known as pharmacy benefit managers (PBMs). Negotiations between pharmaceutical companies, health insurers, PBMs and others result in significant rebates and discounts that totaled $236 billion in 2021.

Health Insurance Companies 231

Health Insurance Companies Insurance Pharmaceutical Companies Pharmaceutical Companies 231

Fierce Pharma

SEPTEMBER 24, 2024

drug prices, the role of insurers and pharmacy benefit managers (PBMs) often commands at least some of the attention. | At the Senate committee hearing on Novo Nordisk's prices for Ozempic and Wegovy, debate around insurance coverage and pharmacy benefit managers took up much of the conversation.

Insurance 110

Insurance Insurance Coverage 110

STAT

DECEMBER 13, 2024

I just didn’t know I would also have to fight against insurance companies denying me access to life-extending treatments. When I was diagnosed at age 22 with ALS, a fatal disease without a cure, I knew I was going to have to fight for my life.

Insurance 108

Insurance 108

PhRMA

MAY 10, 2023

These are the middlemen that insurance companies use to determine what’s covered and what patients pay out of pocket at the pharmacy. We expect the hearing will shed light on the misaligned incentives in the system that allow these middlemen and insurance companies to drive affordability and access challenges for patients.

Insurance 212

Insurance 212