Overcoming insurance hurdles for critical medications; rising heat and wildfires reverse decades of clean air progress; conflicts between parents and schools arise as teens seek mental health support
Battling Insurance Hurdles: Prior Authorization
Patients seeking critical medications who have faced insurance coverage denials due to the prior authorization process may benefit from several pending bills backed by the AMA, according to Kaiser Health News. The pending bills include several policies for quicker response times, public reporting of insurer’s prior authorization determinations, and programs to reduce volume of requests. These policies are sometimes called “gold carding,” and have been passed in some form in 5 states, with the AMA currently tracking active gold carding bills in 13 states.
Climate Change Reverses Decades of Clean Air Progress in the US
A new study by the climate analytics firm First Street Foundation warned that blistering heat waves and more frequent wildfires are causing a reversal in clean air gains achieved over past decades in the US, according to The Hill. By midcentury, air quality levels are projected to return to levels not seen since 2004, as microscopic soot particles and ozone molecules surge, posing significant health risks to Americans. The study highlights the urgent need for robust climate action and emphasizes the challenges in regulating climate compared with industrial emissions.
Navigating Consent: Challenges in Youth Mental Health Treatment
As schools grapple with a youth mental health crisis, conflicts between parents and schools over treatment consent are emerging, according to The Associated Press. Differing perspectives on mental health, coupled with legal and financial barriers, pose challenges for teens seeking therapy. The issue has become politicized, with some states streamlining access while others propose restrictions, leaving young people to navigate complex paths to mental health support.
NCCN Data Find Racial, Socioeconomic Disparities in Quality of Care for Metastatic Pancreatic Cancer
April 9th 2025New data from the National Comprehensive Cancer Network (NCCN) reveal that socially vulnerable and minority patients with metastatic pancreatic cancer are less likely to receive recommended treatments and achieve longer survival.
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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.
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
Organizational Factors Associated With Variation in Primary Care Providers in ACOs
April 8th 2025A higher percentage of accountable care organization (ACO) primary care providers was associated with physician leadership, upside financial risk, and financial compensation of physicians tied to performance measures.
Read More
NCCN Data Find Racial, Socioeconomic Disparities in Quality of Care for Metastatic Pancreatic Cancer
April 9th 2025New data from the National Comprehensive Cancer Network (NCCN) reveal that socially vulnerable and minority patients with metastatic pancreatic cancer are less likely to receive recommended treatments and achieve longer survival.
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
Organizational Factors Associated With Variation in Primary Care Providers in ACOs
April 8th 2025A higher percentage of accountable care organization (ACO) primary care providers was associated with physician leadership, upside financial risk, and financial compensation of physicians tied to performance measures.
Read More
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