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What We’re Reading: Health Insurers to Cut PA Process; Bipartisan Bill to Stop MA Overpayments; J&J Ends RSV Vaccine Work
Payers are looking to roll back on paperwork requirements for prior authorization (PA); CMS and Medicare Advantage (MA) insurers battle over new regulations; Johnson & Johnson (J&J) falls behind Pfizer and GSK for vaccine approval.
Health Insurers Seek to Reduce Medical Paperwork Due to Prior Authorization
UnitedHealthcare, Cigna, and Aetna have announced new cuts to their use of the prior authorization process, according to The Wall Street Journal. These cuts would not only remove many procedures and medical devices that require signoffs but would remove many prior authorization requirements for doctors and hospitals whose requests are nearly always approved.
Bipartisan Bill Aims to Stop MA Up-coding Practices Leading to Overpayments
New legislation hopes to stop overpayments to Medicare Advantage (MA) plans after feuding with the CMS over risk adjustment, according to Fierce Healthcare. The bill aims to remove financial incentives for MA plans to no longer need to make risk adjustments to get higher Medicare payments. If signed, the bill would also remove diagnoses from chart reviews and health risk assessments when calculating a patient’s risk score.
J&J Ducks Out of Race for Approval of the World’s First RSV Vaccine
Johnson & Johnson (J&J) announced that it is backing out of the race for approval of the world’s first respiratory syndactyl virus (RSV) vaccine, according to CNBC. This decision came after rivals Pfizer and GSK made big strides toward approval of their vaccines, while J&J lagged behind. The company announced in a press release that it will stop working on its investigational RSV program and will discontinue its phase 3 trial testing shot.
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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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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