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Court Validates Highmark Medicare Plan that Excludes UPMC
Highmark Inc. won a court ruling Thursday allowing it to exclude UPMC hospitals and doctors from some plans it sells to seniors.
Highmark Inc. won a court ruling Thursday allowing it to exclude University of Pittsburgh Medical Center (UPMC) hospitals and doctors from some plans it sells to seniors.
Commonwealth Court President Judge Dan Pellegrini denied a request by Attorney General Kathleen Kane and Gov. Tom Corbett's administration to hold Highmark in contempt of a consent decree the state's largest health insurer signed this summer.
Highmark said it will continue selling the Community Blue Medicare Advantage plans, which are less expensive alternatives to broad-network Highmark plans for seniors that include full in-network access to UPMC, the biggest hospital network in Western Pennsylvania.
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Comparing Breast Cancer Treatment Outcomes Between Fee-for-Service and Medicare Advantage
April 4th 2025This study examined postdiagnosis breast cancer treatment outcomes for Medicare Advantage vs fee-for-service (FFS) Medicare in Ohio and found no significant differences overall but disparities for Black patients with FFS Medicare.
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Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On 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.
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Neurologists Share Tips for Securing Patient Access to Gene Therapies
March 19th 2025Tenacious 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.
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How Access to SMA Treatment Varies Globally and by Insurance Type
March 18th 2025Posters presented at the 2025 Muscular Dystrophy Association (MDA) Clinical & Scientific Conference show that therapeutic advances in treating spinal muscular atrophy (SMA) are not uniformly making it into the hands of patients who could benefit.
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