HealthPayerIntelligence News

AHIP, BCBSA Voice Concerns About Proposed Prior Authorization Rule

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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...

UHC Reports 13% Revenue Growth in Q2 2023 Due to Rising Enrollment

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UnitedHealth Group’s earnings call for the second quarter of 2023 featured revenue growth due to strong performance from the healthcare company’s insurance arm, UnitedHealthcare, and its...

Cigna Healthcare Boosts Treatment Access with New Biosimilar Coverage

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Cigna Healthcare has added four Humira biosimilars to its formularies, aiming to increase member access to affordable treatments. Cigna Pharmacy Management, Cigna’s provider of pharmacy...

Medicaid Expansion Improved Palliative Care Access for Cancer Patients

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Medicaid beneficiaries with late-stage cancer might have greater access to palliative care in states that have adopted Medicaid expansion, a study published in Health Affairs found. The researchers...

Medicare Advantage Quality Bonus Program Needs Reform, Report Finds

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The Medicare Advantage quality bonus program overpays plans and does not effectively promote quality care, indicating that program reforms are needed, according to an Urban Institute report. The...

English Proficiency Can Impact Care Disparities, Coverage Rates

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Limited English proficiency (LEP) can significantly stunt a patient’s ability to communicate with doctors and receive care, which results in broader care disparities along racial and ethnic...

ARPA Reduced Fiscal Challenges on CA Affordable Care Act Marketplace

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Enrollees in California’s Affordable Care Act marketplace were less likely to experience financial barriers in 2021 compared to 2017 due to provisions in the American Rescue Plan Act (ARPA) that...

Humana Foundation Supports Initiative to End Veteran Suicide

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The Humana Foundation is supporting a new initiative that aims to reduce veteran suicide and promote mental healthcare. USAA and the USAA Foundation established the Face the Fight initiative to raise...