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

Pharmacy Times

DECEMBER 21, 2023

Overtime, children can outgrow food allergies, like milk and eggs—however, children with private insurance are more likely to outgrow allergies than those with public insurance.

Insurance 145

Insurance 145

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 142

Insurance 142

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 7, 2024

In recent months, the federal government has repeatedly told Medicare Advantage insurers that they cannot use artificial intelligence or algorithms to deny medical services the government routinely covers.

Insurance 140

Insurance 140

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 133

Insurance Hospitals 133

STAT

JULY 25, 2024

Insurers like UnitedHealth are profiting off of the Medicare Advantage system, and it’s causing problems for both doctors and patients. Traditional Medicare is run by the federal government, while Medicare Advantage health insurance plans are operated by private companies like UnitedHealth. Read the rest…

Insurance 119

Insurance Hospitals 119

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 141

Insurance Hospitals Insurance Processing 141

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 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 142

Insurance Medical Records 142

STAT

DECEMBER 12, 2024

Like many Americans, Holden Karau said she was fed up with health insurance. The software engineer’s disillusionment began in 2019, when her insurer, UnitedHealthcare, balked at covering physical therapy after she was hit by a car and could not walk.

Insurance 110

Insurance 110

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 136

Insurance Hospitals 136

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 118

Insurance 118

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 127

Insurance 127

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

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 124

Insurance 124

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 133

Insurance 133

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

The Checkup by Singlecare

DECEMBER 10, 2024

Related: Modafinil dosage | Modafinil side effects | Modafinil coupon | Modafinil details Is Modafinil covered by insurance? Determining whether your insurance company covers modafinil requires a look at the plans drug formulary. How much does Modafinil cost without insurance? The post How much is Modafinil without insurance?

Insurance 98

Insurance Dosage FDA 98

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

Fierce Healthcare

FEBRUARY 1, 2024

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 127

Insurance Hospitals 127

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

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

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 117

Insurance 117

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 112

Insurance Health Insurance Companies 112

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 124

Insurance 124

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

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 129

Insurance Insurance Coverage 129

Fierce Healthcare

JUNE 17, 2024

Insured patients are often better off buying their generic prescriptions through their health insurance benefits than through Mark Cuban Cost Plus Drug Company, though those without insurance could | Only about 12% of generic prescription fills bring higher costs than the billionaire-backed pharmacy, with median savings among these landing at about (..)

Insurance 113

Insurance Prescription Filling 113

The Checkup by Singlecare

AUGUST 20, 2024

Without insurance, the cost of Stiolto Respimat can be over $600 per month. For many people, the retail price of Stiolto Respimat can make getting treatment difficult without insurance coverage. Is Stiolto Respimat covered by insurance? Yes, some insurance companies may include Stiolto Respimat in their coverage plans.

Insurance 98

Insurance Insurance Coverage Health Insurance Companies FDA 98

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 105

Insurance 105

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

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 95

Insurance Health Insurance Companies 95

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

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 102

Insurance 102