Insurance

Authors from Facing Our Risk of Cancer Empowered (FORCE), a nonprofit organization focused on hereditary cancer, discuss the importance of genetic testing, guidelines, and coverage considerations.

A class-action trial begins Monday in Hartford, Connecticut seeking to end Medicare regulations around something called “observation care” in the hospital; California hospitals are providing significantly less free and discounted care to low-income patients because the Affordable Care Act reduced the number of uninsured patients; The American Academy of Pediatrics released its first policy statement about how racism affects the health and development of children and adolescents.

The FDA ordered 4 companies to stop selling 44 of their flavored e-liquid and hookah tobacco products that lack the required approval for sale; CMS has yet to implement a 2014 law preventing unnecessary, expensive screening tests (magnetic resonance imaging, computed tomagraphy scans and other tests) that could harm patients and waste resources; Amarin, which is seeking FDA approval for an expansion of Vascepa labeling to include data that showed a 25% reduction in the risk of heart attacks and strokes, said the FDA has scheduled an advisory committee meeting for November 14.

In a long-awaited national coverage determination decision, CMS said Wednesday that it approved chimeric antigen receptor (CAR) T-cell therapies for Medicare beneficiaries nationwide.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Hospices will receive a $520 million increase in payments from CMS in fiscal year 2020; urban areas accounted for more drug overdose deaths rates than rural areas in 2016 and 2017; a federal judge has ruled that a lawsuit against a California price transparency law can proceed.

This week, the top managed care news included HHS laying out a plan for importing certain prescription drugs from other countries; a potential new standard of care for chronic lymphocytic leukemia; 3 insulin makers get subpoenaed over their pricing practices.

Low- and middle- income Medicare beneficiaries face increasing financial burden as employer coverage erodes.

Tuesday's Democratic presidential debate, the first of 2 days, included disagreements over the viability of Medicare for All; 3 insulin makers received subpoenas from the New York Attorney General over their pricing practices; US News & Report released its 30th Annual Best Hospitals rankings.

CMS announced changes to make it easier for the consumer to know what they are paying for in healthcare and for physicians to manage chronic conditions.

CMS said it is piloting the integration of Medicare historical claims data into electronic health records to give physicians more information about their patients at the time of an office visit.

This past week saw several pieces of legislation introduced to lower the cost of prescription drug prices. Here are 5 ways patients and providers would be affected by the bills.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

A new report from the HHS’ Office of the Inspector General praises 20 high-performing accountable care organizations (ACOs) for the strategies they are using in the shift to value-based care.

President Trump is preparing an executive order that would slash prices on nearly all drugs sold to Medicare; Allergan has recalled certain breast implants following 573 cases of implant-associated anaplastic large cell lymphoma; a study has found 1 in 4 people intend to use antibiotics without a prescription.

Spearheaded by Senate Finance Committee Chairman Chuck Grassley, R-Iowa, and Ranking Member Ron Wyden, D-Oregon, the bipartisan bill would lower out-of-pocket (OOP) costs for Medicare and Medicaid beneficiaries and save the government billions.

The bill would reduce prices up to 75% based on anticipated 2020 levels, according to Senator Jeanne Shaheen, D-NH, the lead sponsor.

Depending on how ready accountable care organizations (ACOs) are to move to risk probably affects how they view CMS’ decision to transition the Medicare Shared Savings Program (MSSP) to Pathways to Success, said Travis Broome, vice president of policy at Aledade.

As the fate of the Affordable Care Act (ACA) remains uncertain, 21 million people are at risk of losing their health insurance. In addition to large coverage gains as a result of the ACA, the law resulted in various other sweeping changes to the US healthcare system. Here are 5 things that would be impacted if the ACA is overturned.

Two reports from the Office of Inspector General (OIG) in HHS have identified deficiencies in the quality of care at hospices and the harm done to beneficiaries as a result of poor care or cases of abuse.

The Federal Communications Commission has proposed the 3-year, $100 million program to bring telehealth to low-income patients, veterans, and areas lacking access to adequate healthcare; use of opioids in Medicare Part D declined in 2018 as use of medication-assisted treatment increased; a House committee held a hearing on identifying, preventing, and treating childhood trauma as a public health issue.

US District Court Judge Amit P. Mehta has ruled that HHS does not have the authority to require drug manufacturers to list the prices of their drugs in television ads.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Changes to Medigap as part of the Medicare Access and CHIP Reauthorization Act go into action beginning next year.

Some generic drugs may actually cost Medicare Part D beneficiaries more out-of-pocket than brand-name drugs because brand-name manufacturers can offer discounts that generic drug makers cannot pay.

This week, we recap the top managed care news from the first half of 2019, including outcomes from some of the biggest diabetes trials, research into the annual Medicare wellness visit, and an experimental treatment in Parkinson disease.

Leaders of the Senate Finance Committee have discussed a deal to limit drug prices in Medicare; Louisiana Governor John Bel Edwards will annouce a "Netflix model" deal with Aseuga Therapeutics that will increase access to an effective Hepatitis C drug, AbbVie has annouced a $63 billion transaction agreement to acquire Allergan.

Since 2007, the number of enrollees without low-income subsidies who had spending above the catastrophic threshold has more than doubled, reaching 1 million enrollees in 2015, 2016, and 2017.

With the expected surge of aging Americans over the next few decades, states are trying to prepare for a wave of Alzheimer disease and dementia, which carries with it an enormous societal burden, extracting a toll on families and caregivers, and impacts state Medicaid budgets. In response, nearly every state is turning to Alzheimer action plans to try to cope with what is coming in the years ahead.

Value-based care has been a big prerogative of CMS for the last decade, and it's not going away, Brian Kern, a lawyer with Frier Levitt, told Amy Ellis, director of quality and value-based care at Northwest Medical Specialties.