by Jessica Casebolt | Mar 20, 2023 | Payers, Tea Leaves
A group of House lawmakers is hoping to outlaw the use of spread pricing by pharmacy benefit managers (PBMs) in the Medicaid program. The Drug Transparency in Medicaid Act, reintroduced Friday, is the latest PBM reform bill launched by this Congress. The bipartisan...
by Jessica Casebolt | Mar 16, 2023 | Payers, Tea Leaves
As the public health emergency ends, Medicaid enrollees and the health insurance companies that cover them face major disruptions in the coming months as states resume removing people who no longer qualify for the program. A Modern Healthcare article states that an...
by Jessica Casebolt | Mar 14, 2023 | Payers, Tea Leaves
Thousands of patients have called on a federal court to reverse a landmark ruling allowing a UnitedHealth Group subsidiary to develop mental and substance abuse coverage guidelines they allege deviate from clinical standards. The American Medical Association, the...
by Jessica Casebolt | Mar 2, 2023 | Payers, Tea Leaves
Health insurers’ margins in Medicare Advantage were more than double those seen in other markets in 2021, reinforcing the way the program can produce strong financial returns for plans, a new Kaiser Family Foundation analysis shows. Private Medicare plans are...
by Jessica Casebolt | Feb 28, 2023 | Payers, Tea Leaves
A new study found that Medicare Advantage (MA) had fewer avoidable hospitalizations for acute conditions compared to traditional Medicare, a trend that may be caused by shifting patients to other sites of care. The study, published in the Journal of the American...
by Jessica Casebolt | Feb 27, 2023 | Payers, Tea Leaves
Payers should be keeping a close eye on developments in the drug pipeline for Alzheimer’s disease therapies—and how the Centers for Medicare & Medicaid Services (CMS) responds to those developments, according to a new report from Optum. The report...
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