Insurance

In the second part of our interview with John M. O'Brien, PharmD, MPH, of the National Pharmaceutical Council (NPC), he calls for further research into employer choices and the influence of benefit consultants in the pharmacy benefit manager (PBM) and drug rebate landscape.

Real-world cross-validation of insurer and hospital price transparency data finds low overlap but high concordance between data sources.

There will likely be a 7% increase in Affordable Care Act (ACA) Marketplace plan premiums next year across the 324 participating insurers from the 50 states and Washington, DC.

John M. O'Brien, PharmD, MPH, of the National Pharmaceutical Council, discusses his recent study, which sheds light on how important rebates are when choosing benefits for employers and who advises employers on these choices.

This article reviews the obesity epidemic in America and discusses inadequate insurance coverage.

Almost half of insured Americans report receiving unexpected medical bills, leading to financial strain and contributing to worsening health outcomes for many patients, The Commonwealth Fund report reveals.

The Center on Health Equity & Access reported on new research in youth mental health, with expert perspectives on HIV, liver cancer, and health outreach.

As pharmacy benefit managers (PBMs) come under increased scrutiny from regulatory agencies, here are 5 things to know about their role in the health care system.

This week, the Center on Health Equity & Access delved into the state of equity as it relates to national spending, ovarian cancer care, health technology, insurance coverage, and postpartum depression.

For Minority Mental Health Awareness Month, the Employee Benefits Security Agency (EBSA) in the US Department of Labor highlights the critical need to address mental health disparities among racial and ethnic minorities.

Melissa Clarke, MD, CMQ, the chief health equity officer at Elevance Health, explains "Health Equity by Design" and how Elevance Health is committed to ensuring a personalized and intentional approach for all its members.

New rules aim to curb insurance brokers and protect consumers; data highlights surge in post-pandemic hospital-onset infections; President Biden’s decision to step down highlights Harris’ stance on health care reform and equity.

The Greater Philadelphia Business Coalition on Health webinar series provided an in-depth framework for the advantages of including cell and gene therapy coverage in employer health plans, as well as the challenges brought by manufacturing complexities and the need to address accessibility to treatment.

Rising COVID-19 cases are attributed to travel, heatwaves, and new variants; an analysis highlights challenges in states not expanding Medicaid; the FDA notes health risks despite marketing authorization for popular e-cigarettes.

Misleading ads are under scrutiny for their role in signing up consumers for Affordable Care Act (ACA) coverage without their permission; Sen Elizabeth Warren (D, Massachusetts) said there are enough votes in the Senate to suspend the filibuster to codify Roe v Wade in 2025 with a Democratic majority; women with endometriosis have about a fourfold risk of developing ovarian cancer.

On this episode of Managed Care Cast, we're talking with the author of a study published in the July 2024 issue of The American Journal of Managed Care® that estimates the insurance value of novel Duchenne muscular dystrophy (DMD) treatment.

Almost half of all Americans struggle to afford quality health care and prescription medications; the cyberattack on UnitedHealth Group's Change Healthcare unit will cost the company between $2.3 billion and $2.45 billion in 2024; CMS releases the final part 2 guidance for plan outreach and education for the Medicare Prescription Payment Plan.

Today, the Siftwell 2024 Medicaid-Eligible Health Equity Index report highlighted ongoing challenges and barriers that underscore the need for systemic changes to improve health care access and outcomes for vulnerable groups.

The Federal Trade Commission (FTC) is preparing a lawsuit against the 3 largest drug middlemen over their use of rebates for insulin and other drugs; Sen Bernie Sanders (I, Vermont) feels confident that Novo Nordisk will cut Ozempic and Wegovy costs after hearing; CMS proposed a payment rule that would increase Medicare reimbursement for hospital outpatient departments by 2.6% next year.

After evaluating the association between the expanded Medicare Advantage supplemental benefits and plan composition, authors determined that adoption was not associated with large demographic shifts in enrollment.

A long-awaited report from the Federal Trade Commission (FTC) finds that vertical integration and consolidation have worked against consumers and independent pharmacies.

Researchers link vaccination and reduced asthma symptoms; providers warn against overburdening and security risks; insurers’ practices lead to questionable diagnoses

Insurers continue to raise consumer costs despite covering fewer drugs and having more drug coverage restrictions; the Biden Administration is investing hundreds of millions of dollars to train geriatricians; the Federal Trade Commission has opened an investigation into Teva Pharmaceuticals after the company refused to take down patents for its asthma and chronic obstructive pulmonary disease inhalers.

The use of Plan B fell by 60% in states that implemented near-total abortion bans after Roe v. Wade was overturned; the Biden administration will impose inflation penalties on 64 prescription drugs in the third quarter of 2024; the FDA recently released draft guidance to ensure that drug companies and medical device makers enroll more women and people of color in clinical trials.

On this episode of Managed Care Cast, we're talking with the author of a study published in the June 2024 issue of The American Journal of Managed Care® about how annual high-deductible insurance plans increase maternity care costs when pregnancies cross 2 calendar years.

The CDC issued a warning to doctors on Tuesday to look out for dengue cases amid a global surge; HHS has finalized disincentives to prevent health care organizations from unreasonably blocking the exchange of electronic health record (EHR) information; patients in some states, like West Virginia, cannot afford weight-loss medications due to the high costs and lack of insurance coverage.

Beneficiaries who switched from traditional Medicare to a Medicare Advantage plan experienced no additional protection from medical costs compared with those who stayed in a traditional Medicare plan.

A federal appeals court has ruled a key part of the Affordable Care Act (ACA) unconstitutional, which allows a health task force to require insurers to cover preventive health measures without out-of-pocket costs; the FDA’s recent decision to authorize 4 menthol vaping products drew harsh criticism from pediatricians and antitobacco groups; rising health care prices are lowering American wages and causing job losses.

The US Preventive Services Task Force recommends that kids 6 years and older with a high body mass index receive intensive behavioral interventions; Amazon’s pharmacy unit is expanding eligibility for RxPass to patients enrolled in Medicare insurance plans; Sen Bernie Sanders (I, Vermont) is trying to lower the prices of popular antiobesity drugs.

The rate of uninsured Americans will rise to 8.9% over the next decade; Senator Bernie Sanders (I, Vermont) wants a government watchdog to investigate why women are still being charged for contraception considered free under federal law, and proposed Medicare Advantage Star Ratings target top performers.