Public Payers News

FDA approval of Wegovy expands coverage access for Medicare beneficiaries

April 24, 2024 - Following new FDA approvals for Wegovy, one in four Medicare beneficiaries with obesity may gain coverage access to the drug to reduce the risk of heart attacks and stroke, according to KFF data. The FDA’s approval of using Wegovy to combat the risk of heart attacks and stroke in people with cardiovascular disease who are overweight or obese...

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Medicaid final rules improve care access for managed care, FFS beneficiaries

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CMS has finalized policies to improve access to Medicaid and the Children’s Health Insurance Program (CHIP) managed care and boost coverage quality. The Medicaid and Children’s Health...

23% of disenrolled Medicaid beneficiaries remain uninsured, KFF finds

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Nearly one in four people who were disenrolled from Medicaid remain uninsured, citing costs as barriers to coverage, according to a KFF poll. Since states resumed conducting Medicaid eligibility...

Medicare Advantage final rule addresses competition and marketing practices

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CMS has finalized policies to promote competition in Medicare Advantage and Part D plans, boost access to behavioral healthcare services, and reduce deceptive marketing practices. The Contract Year...

Expanding Medicaid eligibility in GA would reduce uninsurance by 28%

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Expanding Medicaid eligibility in Georgia would help reduce uninsurance among non-elderly individuals by almost 300,000 people, according to a report from the Urban Institute and the Robert Wood...

CMS final rule improves access to Affordable Care Act marketplace coverage

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CMS has finalized policies to increase access to marketplace coverage and expand essential health benefits (EHBs) in the HHS 2025 Notice of Benefit and Payment Parameters final rule. “Access to...

HHS extends special enrollment period for former Medicaid beneficiaries

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HHS has extended the temporary special enrollment period to facilitate marketplace enrollment for beneficiaries who lost Medicaid or Children’s Health Insurance Program (CHIP) coverage following...

Medicare spending on GLP-1 drugs reached $5.7 billion in 2022

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Medicare spending on GLP-1 drugs, including Ozempic, surpassed $5 billion in 2022 and is likely to continue growing as coverage expands, according to a KFF analysis. GLP-1 drugs Ozempic, Wegovy, and...

CMS final rule aims to simplify Medicaid, CHIP enrollment, coverage

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A new CMS final rule, the “Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal...

Medicaid disenrollments surpass 18M, exceeding HHS projections

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More than 18 million beneficiaries have been disenrolled from Medicaid since the public health emergency ended and states resumed coverage determinations, according to data from...

Healthcare spending is higher in Medicare households, study finds

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Healthcare spending is higher in households where Medicare covers all members, a KFF issue brief found. Around 66 million adults receive health insurance coverage through Medicare, including 59...

Continuous Medicaid eligibility during PHE improved postpartum coverage

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The continuous Medicaid eligibility requirement during the COVID-19 public health emergency was associated with increased postpartum Medicaid enrollment and reduced uninsurance, according to a study...

2024 Medicare Advantage premiums remain low and stable

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The average Medicare Advantage premium has remained low and stable, with many beneficiaries choosing plans with a zero-dollar monthly premium, according to data from eHealth, Inc. eHealth’s...

Medicare Advantage enrollment increased by 1.7 million beneficiaries

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Medicare Advantage enrollment has increased by 1.7 million beneficiaries since 2023, with for-profit health plans dominating the market, a Chartis report revealed. Among 65.9 million Medicare-eligible...

Few Physicians Participate in Both Medicaid and Marketplace Plans

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Less than three in ten primary care physicians participating in Medicaid also participated in an average marketplace network, raising concerns about continuity of care for beneficiaries disenrolled...

Utilization Restrictions on Medicare Part D Drugs Increased, Study Finds

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Utilization restrictions on Medicare Part D drugs, including prior authorization and formulary restrictions, increased over time between 2011 and 2020, according to a Health Affairs study. Pharmacy...

Medicare Advantage Beneficiaries Receive Less Home Healthcare Services

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Medicare Advantage beneficiaries received shorter and less intensive home healthcare services than those in traditional Medicare, a study published in JAMA Health Forum found. The Medicare home...

MA Payment Reductions May Impact Value of Healthcare for Beneficiaries

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The proposed 2025 Medicare Advantage Advance Notice would impact the value of healthcare for beneficiaries, resulting in higher costs, according to an analysis from the Berkeley Research Group...

Care Access, Coverage Value Similar in Medicare Advantage and Medicare

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Coverage and care experiences were generally similar for Medicare Advantage and traditional Medicare beneficiaries, but instances of care delays and health assessments differed, a survey from the...

CareSource Partnership Boosts Access to Substance Use Disorder Treatment

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CareSource has partnered with CKF Addiction Treatment to improve member access to substance use disorder treatment in Central Kansas. “Our shared commitment to decreasing substance use disorder...

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