Insurance

Patients and physicians are publicly shaming insurance companies on social media for the troublesome prior authorization process; HHS has awarded $1.4 billion in grants for the creation of new technologies and tools to prevent COVID-19 infection; Novo Nordisk has increased lobbying efforts to allow Medicare coverage of weight loss drugs.

Clinicians and nurses who treat patients with hemophilia with a gene therapy identified important factors and considerations needed in a potential shared decision making tool.

A new CMS proposal would authorize Medicare payments to cover family caregiver training; US list prices for popular weight loss drugs are higher than those of other wealthy nations; Midwestern cities declare themselves sanctuary cities despite anti-LGBT state laws passed.

Data on 10 social determinants of health (SDOH) were analyzed to determine their distribution among low-income patients hospitalized for heart failure (HF) at a safety-net hospital.

The program, which scales an accountable care organization (ACO) model across all major payers in Vermont, reduced Medicare spending and hospitalizations while improving patient care.

Novo Nordisk continues to limit starter doses of popular weight-loss drug Wegovy in the US; veterans and survivors received an error message when submitting PACT Act claims shortly before the deadline; insurance companies are failing to inform patients of their eligibility for free preventative services.

The Red Cross’s inclusive assessment will determine blood donation eligibility; Wegovy reduces the risk of cardiovascular events; the first postpartum depression pill sparks pricing questions.

A record low of 7.7% of Americans had no health insurance at the start of 2023; the American Academy of Pediatrics renewed its backing of gender care for children while requesting a research review; 2 lots of an oral contraceptive were recalled for possible reduction in effectiveness.

There is a right way and a wrong way to inform a patient about a switch from the reference product to a biosimilar, explained Laura Wingate, executive vice president, Education, Support, & Advocacy, Crohn's & Colitis Foundation.

Debra Patt, MD, PhD, MBA, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for episode 2 of our newest podcast, "Oncology Onward: Conversations With Innovators and Changemakers in Cancer Care."

Some of the many barriers patients with hidradenitis suppurativa (HS) face include accessing knowledgeable providers, insurance coverage of treatment, and the way the health care system is set up, said Haley Naik, MD, FAAD, associate professor of dermatology, University of California, San Francisco, School of Medicine.

The proposed fee schedule for 2024 would reduce payments by 3.4%. Most responses were swift and negative.

Residence in a more disadvantaged neighborhood was associated with higher likelihood of being a high-cost utilizer among older adults and lower likelihood among younger adults.

Off-marketplace plans are widely available, and individuals with higher incomes can obtain silver plans with low premiums off-marketplace.

An online survey identified that documentation requirements and communication issues with health plans are associated with providers modifying clinical decisions to avoid medication prior authorization.

Medication formulary policies represent a key determinant of access to medication and can be leveraged to advance pharmacoequity and health equity writ large.

In March 2023, national telehealth utilization rose 1.8%, up from 5.5% of medical claim lines in February, according to new data from FAIR Health’s Monthly Telehealth Regional Tracker.

At the 2023 Greater Philadelphia Business Coalition on Health annual conference, a panel of employers shared their advice on incorporating the principles of value into health benefits.

The FDA approved Pfizer’s respiratory syncytial virus (RSV) vaccine Wednesday; Medicare announced plans to largely cover a new class of expensive Alzheimer drugs; more states are extending postpartum coverage under Medicaid.

Insurance is by far the most important factor of whether patients followed up with treatment after getting screened for glaucoma, said Byron L. Lam, MD, professor of ophthalmology, University of Miami Miller School of Medicine's Bascom Palmer Eye Institute.

At the 2023 Greater Philadelphia Business Coalition on Health, panelists described the ways their organizations are promoting access to primary care in hopes that it can be part of the progress toward achieving the Quadruple Aim of lower costs, better outcomes, patient satisfaction, and clinician experience.

Kicking off the 2023 Greater Philadelphia Business Coalition on Health annual conference, Mark Fendrick, MD, of the University of Michigan, delivered a keynote exhorting the audience of employers and payers to implement the principles of value-based insurance design (VBID) in order to improve individual and population health and drive toward equity.

Although acne and rosacea treatment are widely covered, treatment for other types of skin conditions are not covered at all, a new report shows.

Medicare Part D low-income subsidies alone are insufficient to improve the uptake and equitable use of high-cost, orally administered antimyeloma therapy.

If approved by the FDA, sotatercept would be the first therapy that acts directly against the cause of the disease.

Although commercial accountable care organization populations are healthy on average, some individuals might benefit from programs for high-risk patients to mitigate high levels of health care utilization.

Increases in Medicare Advantage market share over the past 10 years are largely caused by an increased preference for managed care among Medicare beneficiaries.

Gene therapy has the promise of being one and done, but it isn’t always that way for all patients, which leaves questions about where these therapies fit in the commercial landscape, said Charles C. Wykoff, MD, PhD, of Retina Consultants of Texas and the Blanton Eye Institute at Houston Methodist Hospital.

A study assessing factors that may determine a commercial health plan’s likelihood of covering a biosimilar found that biosimilars that are cancer therapies, used to treat children, indicated for highly prevalent conditions, or only competing against the originator were more likely to have coverage restrictions.

This quantitative and qualitative analysis highlights differences in prior authorization requirements for migraine drugs from nearly 50 managed care organizations and summarizes broad types of criteria used.