Insurance

As Medicare Advantage increasingly becomes the dominant form of Medicare coverage, Congress must improve transparency of programmatic costs and benefits to promote beneficiary choice.

Brindley Brooks, who founded HS Connect (HSconnect.org), a patient advocacy group for those affected with hidradenitis suppurativa (HS), discussed step edits and other barriers to treatment caused by insurance requirements in the management of HS.

Most patients with atopic dermatitis had flunctuating levels of depressive symptoms, with having public or no insurance, more severe itch, and skin pain cited as additional predictors of adverse mental health outcomes.

We estimate that the median 2021 premium tax credit for off-marketplace enrollees in California would be $311 if they switched to marketplace plans, with wide variation by age and plan size.

Medicaid expansion was associated with substantial changes in Medicaid managed care plan composition, which may influence a plan’s performance on enrollee experience metrics.

Limiting access to non–vitamin K antagonist oral anticoagulants through step therapy and prior authorization may exacerbate current underuse of anticoagulants and increase the risk of stroke in patients with newly diagnosed atrial fibrillation.

A recent study calculated the incidence and mortality rates for patients with Medicaid coverage who had nonventilator hospital-acquired pneumonia (NVHAP) and found possible associations between greater health care costs and NVHAP diagnosis.

More people are eligible for screening, but a new analysis suggests lung cancer disparities are due to more than eligibility status.

Clinical trials and targeted agents do not appear to affect health care–related quality of life, however.

This study developed a novel algorithm for setting automatic auditing thresholds in a Medicaid program in Maryland.

This study attempts to identify the sources of the significant 2.5-fold variation found in home health expenditures, a possible indicator of inefficiency and waste.

Four large Medicare Advantage insurers manage access to expensive physician-administered drugs with a combination of prior authorization, step therapy, and Part D formulary design.

Patients who received a diagnosis of small cell lung cancer (SCLC) between 2010 and 2016 had a nearly 2% increase in overall survival vs those who received their diagnosis between 2004 and 2010.

Most patients taking a biologic stayed on the therapy, and most saw decreases in exacerbations, a new study has found.

Imposing a surcharge on unvaccinated employees will require employers to think through legal and policy implications.

As part of the Biosimilars Initiative, British Columbia, Canada, implemented a mandatory switch to biosimilar insulin glargine for patients covered by the province’s drug plan.

Veterans residing in rural areas were less likely to complete annual repeat lung cancer screenings compared with those living in a nonrural location, with reduced uptake of initial lung cancer screening also found among eligible veterans in rural vs nonrural locations.

COVID-19–related hospitalizations are up 17% week over week; an estimated 5 to 14 million Americans could lose their Medicaid coverage this year or next year; the CDC is investigating unexplained cases of severe hepatitis in children.

UPMC Health Plan, RxAnte, and Mosaic Pharmacy Services outlined how they are operating a value-based pharmacy care management program within Community HealthChoices, Pennsylvania’s managed Medicaid long-term services and supports (LTSS) program, at a recent conference.

Using socioeconomic status (SES) as their primary exposure, investigators from McGill University, University of Manitoba, Institut National de Santé Publique du Québec, and Laval University investigated reasons behind insulin pump uptake disparities in the Canadian provinces of Manitoba and Québec.

On this episode of Managed Care Cast, Ari D. Panzer, BS, lead author and researcher, then at Tufts Medical Center—now at Duke University—discusses the findings from his team’s investigation into coverage decisions by health plan insurers of the 66 drugs approved by the FDA in 2018.

Elaine Siegfried, MD, professor of pediatrics and dermatology, Saint Louis University Health Sciences Center, discusses several pediatric patient populations with atopic dermatitis who are candidates for the use of systemic therapies.

This article presents findings from interviews conducted with executives from 29 Medicare Advantage plans regarding plan decision-making processes related to new social risk factor–related benefits.

Without addressing rising costs, the problem of underinsurance in health care coverage will remain, said panelists at the 2022 V-BID Summit, discussing some of the smaller steps that are being proposed or are already in place to try to ease the financial burden.

Despite their intention to protect against coverage denial and/or premium increases, additional state-level Medigap regulations are correlated with lower Medigap enrollment and stronger moral hazard.

An unprecedented level of detail and robustness around interoperability standards is on its way, and on this episode of Managed Care Cast, we speak with Donald Rucker, MD, the former National Coordinator for Health Information Technology in HHS, about what the opportunities and responsibilities for payers are.

Jill Hutt, vice president of member services at the Greater Philadelphia Business Coalition on Health (GPBCH), outlines how Wilmington, Delaware, went about implementing the Diabetes Prevention Program.

A new lawsuit aims to block a $13 billion health insurance acquisition; the CDC is expected to release updated mask guidelines; the European Medicines Agency supports boosters among teenagers for COVID-19.

Speaking during a webinar presented by the National Alliance of Healthcare Purchaser Coalitions, experts weighed the pros and cons of employer high-deductible health plans (HDHPs) and outlined steps to address challenges raised.