Cardiologists Not Happy With SGR 'Fix'

In 2021, UnitedHealth Group received 42% of the $33 billion in additional Medicare Advantage payments from differential coding.

On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.

Prior authorizations create substantial administrative and financial burdens on physicians and patients and can disrupt the continuity of care.

The annual wellness visit is beneficial for patients, providers, and payers with an emphasis on preventive care for early intervention.

The researchers emphasized the need for ongoing research and advocacy to further address drug affordability.

Tenacious efforts at every level, from the individual clinician to the hospital to the state to Congress, will be needed to make sure patients can access life-saving gene therapies for neuromuscular diseases.