Insurance

Due to the frequent rejection of claims for noninvasive ventilators by Medicare Advantage plans, individuals with amyotrophic lateral sclerosis (ALS) are experiencing disproportionately high rates of hospital admissions.

A class action lawsuit was filed against UnitedHealth Group and a subsidiary for allegedly using an algorithm to deny rehabilitation coverage for seriously ill patients; US and China officials are finalizing an agreement to crack down on fentanyl; a study published Tuesday projected global heat deaths to increase by 370% if no action is taken against global warming.

This qualitative study elucidates therapists’ perspectives on barriers to and facilitators of access to telemental health among Medicaid-enrolled youth served by a large safety-net organization.

Investigators propose potential payment models for gene therapies that consider equitable patient access and payer reimbursement.

This 2022 survey of Medicare accountable care organizations (ACOs) shows significant growth in non-Medicare value-based contracts and in contracts with downside risk.

Formulary restrictions can create treatment barriers for patients with atrial fibrillation, including unnecessary delays in treatment and prescription abandonment, with vulnerable populations at greater risk.

Many sleep experts want to permanently stay in the standard time zone; Medicare will cover mental health counselors and marriage and family therapists beginning in January; a new Minnesota law requires hospitals to check if patients are eligible for financial assistance before referring medical debt for collections.

This retrospective cohort study of rural hospitals found that Medicare Advantage penetration increased substantially from 2008 to 2019 and was associated with greater hospital sustainability.

The American Cancer Society expanded eligibility for lung cancer screening; experts advised patients to do their research before choosing a plan from the Affordable Care Act’s insurance marketplaces; Republican-led states partnering with rideshare companies for medical appointment rides.

A report published by the Urban Institute estimates that if the 10 Medicaid nonexpansion states were to implement expansions in 2024, Medicaid enrollment would increase by 5 million people, and 2.3 million fewer individuals would be uninsured

Insurance status is known to be associated with health care access and outcomes, and a recent study found that maternal private insurance is associated with a lower infant mortality rate compared with public Medicaid insurance in the United States.

Half of the surveyed adults reported difficulty affording their health care, and a large proportion said they delayed or avoided care or medication because they couldn’t afford it, often leading to their health problems worsening.

This comprehensive comparative analysis examined the economic and health care resource utilization implications of initiating glucocorticoid and exon-skipping therapy for Duchenne muscular dystrophy (DMD).

Senators advocate for TRICARE to stock and cover the OTC birth control pill; double the amount of health care workers experienced workplace harassment in 2022 compared with 2018; a survey found that young adults in the United States experienced depression and anxiety twice as often as teenagers.

Community oncology practices are witnessing a new dynamic in which more Medicare-eligible patients are still covered by commercial insurance, according to speakers at the Community Oncology Alliance Payer Exchange Summit, held October 23-24, 2023.

A poster presented at AMCP Nexus 2023 reported that payers believe implementing the Inflation Reduction Act (IRA) will impact Medicare Part D plans financially.

At the 2023 COA Payer Exchange Summit being held October 23-24 in Reston, Virginia, Lalan Wilfong, MD, US Oncology Network, emphasizes the importance of oncology care equity, ensuring continuity of care, and enhancing care coordination.

An increasing number of people with employer-sponsored insurance are covered by an insurer that offers Medicare Advantage in the state.

To ensure patients are getting timely access to their treatments, there needs to be better collaboration between payers and providers, said Christine Pfaff, RPh, senior regional director of operations, American Oncology Network.

Ben Urick, PharmD, PhD, of Prime Therapeutics, compares the value of medically integrated specialty pharmacies with that of mail order pharmacies.

Biosimilars are becoming more common as more launch on the market in the United States, but patient and provider education can help speed uptake of these products, explained Bincy Abraham, MD, Houston Methodist – Weill Cornell.

According to the National Cancer Institute, in the year following a cancer diagnosis, the average cost of medical care plus medication exceeds $42,000, with some treatments having a price tag of more than $1 million.

Medicare Part A and B premiums are set to increase by $9.80 next year; 20 experts from various specialties and institutions have developed updated brain death guidelines; many Black patients are strongly affected by multiple COVID-19 infections due to a lack of health insurance and health care access.

In this analysis of more than 97 million commercially insured individuals, investigators found that the COVID-19 pandemic induced a spending shock in 2020 and that health care spending did not recover to baseline until mid-2021.

Patients with Medicare were 5.08 times more likely than patients with private insurance, and 2.81 times more likely than patients with Medicaid, to face a financial barrier to obtaining varenicline and combination nicotine replacement therapy.

Cigna will pay $172 million to resolve allegations that it submitted inaccurate diagnosis codes for Medicare Advantage plan enrollees in order to increase payments from Medicare.

Providers have to know how to manage patients who are hesitant to switch to a biosimilar and payers who have specific preferences about which biosimilar to use.

FDA is investigating fraudulent schemes trafficking counterfeit semaglutide (Ozempic); Moderna plans to begin a late-stage trial of its combined COVID-19 and flu vaccine later this year; CMS will begin restricting predictive software used by insurance companies next year.

The researchers noted that their findings suggest clinicians and policy makers should encourage hepatitis C virus (HCV) treatment in those with unhealthy alcohol consumption or alcohol use disorder (AUD) rather than create barriers to it.

Among Latino men who have sex with men (MSM), access to and use of pre-exposure prophylaxis (PrEP) remain at suboptimal levels, despite this population of individuals having disproportionately high rates of diagnosed HIV in the United States.