AHIP, BCBSA Voice Concerns About Proposed Prior Authorization Rule
AHIP joined the American Hospital Association (AHA), American Medical Association (AMA), and Blue Cross Blue Shield Association (BCBSA) in opposing the prior authorization reformation efforts from CMS...VA Benefit Unawareness Leaves Vets Vulnerable to Healthcare Fraud
Veterans’ lack of awareness about their potential benefits under the Promise to Address Comprehensive Toxics Act (PACT Act) could lead to significant financial losses due to healthcare...Why CMS Paused Medicaid Coverage Redeterminations in 6 States
Almost four months after the Medicaid continuous enrollment provision ended, CMS has paused coverage redeterminations in at least six states. In a press call on July 19, CMS Administrator Chiquita...Biden Admin Proposes Mental Health Parity in Private Health Plans
The Biden-Harris Administration has proposed a rule to improve access to mental healthcare for privately insured Americans by establishing mental health parity requirements. The rule supports the...CA, KY Expand Behavioral Health Services Through Mobile Crisis Teams
The Centers for Medicare and Medicaid Services (CMS) has approved proposals to expand behavioral health services for Medicaid beneficiaries in California and Kentucky through community-based mobile...Consumers Blame Payers, Utilization Management for Delays in Care
Consumers do not agree that insurers are protecting them from high out-of-pocket costs and find that utilization management practices—such as prior authorization and formulary...Humira Price for Commercial Plans Remained Steep Despite High Rebates
Despite increasing rebates, the net price of Humira for Medicaid and commercial health plans in 2020 remained high above the launch price, according to a study published in JAMA Network Open. The...How Mental and Behavioral Health Disparities Impact Adults, Youth
Mental and behavioral health disparities disproportionately impact racial minority groups, people with disabilities, and those who identify as lesbian, gay, or bisexual, a report from UnitedHealth...Medicare Advantage Plans Have Narrow Psychiatrist Networks, Study Finds
Psychiatrist networks in Medicare Advantage plans are narrower than those in Medicaid managed care and Affordable Care Act (ACA) plans, according to a study published in Health Affairs. As demand for...Unnecessary Utilization in CO Leads to $134M in Healthcare Spending
Updated 8/24/2023: This article has been updated to reflect that the share of healthcare spending on low value care was highest in commercial health plans. Previously, the article framed...Generic Insulin Drug Pricing, Access Still Pose Problems for Uninsured
Following up on a promise that Eli Lilly made in 2019, the offices of Senators Elizabeth Warren (D-MA), Richard Blumenthal (D-CT), and Raphael Warnock (D-GA) conducted a survey on the drug pricing and...10 Top-Selling Drugs Accounted for 22% of Medicare Part D Spending
The ten top-selling prescription drugs accounted for more than 20 percent of total gross Medicare Part D spending in 2021, a KFF analysis revealed. Under the Inflation Reduction Act’s Medicare...Sponsored by Real Time Medical Systems