CMS has announced new federal rules that require health insurers to streamline requests to cover treatments; nearly 50,000 veterans used the emergency suicide prevention program launched by the Department of Veteran Affairs in 2023; the FDA recently authorized the first artificial intelligence (AI)-powered medical device to help doctors detect the most common forms of skin cancer.
New Prior Authorization Limits Considered Good First Step
CMS has announced new federal rules that address prior authorization (PA), requiring health insurers to streamline requests to cover treatments, according to Axios. Under these new rules, health insurers have to provide coverage decisions on urgent treatment requests for patients in Medicare Advantage, Medicaid, or Affordable Care Act plans within 72 hours; the deadline is 7 days for nonurgent requests. Also, insurers will be required to disclose PA denial rates, provide more specific denial justifications, and meet new technical standards to streamline the process. Insurers’ PA requirements have recently faced criticism, as they delay patients’ access to care. These new protocols, which largely take effect in 2026, will cut the review process in half for some insurers.
First-Year Veteran Suicide Prevention Program Sees High Usage
Nearly 50,000 veterans used the emergency suicide prevention program launched by the Department of Veteran Affairs (VA) last year, according to The Hill. The VA announced Wednesday that 49,714 veterans took advantage of the program, which allowed those experiencing an acute suicidal crisis to go to any VA or non-VA health facility to receive free emergency care, including emergency department visits, up to 30 days of inpatient or crisis residential care, and up to 90 days of outpatient care and transportation costs. Along with offering potentially life-saving care, the VA noted that the program saved more than $64 million in health care costs.
FDA Authorizes Device to Identify Suspicious Moles
The FDA recently authorized the first artificial intelligence (AI)-powered medical device to help doctors detect the most common forms of skin cancer in patients, according to CBS News. The DermaSensor, a noninvasive handheld device, further evaluates lesions that doctors flag as suspicious. The device uses AI-powered spectroscopy technology to assess cellular and below-the-surface characteristics of lesions, and provides real-time results based on an AI algorithm trained on data from more than 4000 malignant and benign lesions. The DermaSensor delivers a “spectral similarity score” for a patient’s mole or lesion by comparing it with known cases, complementing a physician’s assessment. The FDA noted that the device should only be used on patients aged 40 and up.
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.
Listen
Lp(a) and Getting a Head Start Against Heart Disease: Jeremy Wigginton, MD
April 8th 2025Lipoprotein a (Lp[a]) is a valuable tool for assessing a patient's risk of cardiovascular disease, which can facilitate earlier intervention efforts and reduce health care costs, argued Jeremy Wigginton, MD.
Read More
Worse CTD-PAH Prognosis Seen With Higher HFA-PEFF Score
April 8th 2025The findings from this single-center retrospective study compare outcomes between 2 groups of patients living with connective tissue disease–associated pulmonary arterial hypertension (CTD-PAH) stratified by their Heart Failure Association–preserved ejection fraction (HFA-PEFF) algorithm score.
Read More
Guselkumab Shows Sustained Efficacy in Phase 3b APEX Study for Active PsA
April 8th 2025Long-term extension analysis of the phase 3b APEX study (NCT04882098) through 3 years of treatment will further assess the sustained efficacy of guselkumab (Tremfya; Johnson & Johnson) in limiting structural damage in patients with active psoriatic arthritis (PsA).
Read More
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.
Listen
Lp(a) and Getting a Head Start Against Heart Disease: Jeremy Wigginton, MD
April 8th 2025Lipoprotein a (Lp[a]) is a valuable tool for assessing a patient's risk of cardiovascular disease, which can facilitate earlier intervention efforts and reduce health care costs, argued Jeremy Wigginton, MD.
Read More
Worse CTD-PAH Prognosis Seen With Higher HFA-PEFF Score
April 8th 2025The findings from this single-center retrospective study compare outcomes between 2 groups of patients living with connective tissue disease–associated pulmonary arterial hypertension (CTD-PAH) stratified by their Heart Failure Association–preserved ejection fraction (HFA-PEFF) algorithm score.
Read More
Guselkumab Shows Sustained Efficacy in Phase 3b APEX Study for Active PsA
April 8th 2025Long-term extension analysis of the phase 3b APEX study (NCT04882098) through 3 years of treatment will further assess the sustained efficacy of guselkumab (Tremfya; Johnson & Johnson) in limiting structural damage in patients with active psoriatic arthritis (PsA).
Read More
2 Commerce Drive
Cranbury, NJ 08512