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186 Matching News Items

1.  Payers, Providers Share Diverging Asks for ERISA Updates
FierceHealthcare Link to more items from this source
Mar. 19, 2024
"ERISA is turning 50 this year and lawmakers are curious to hear about how the law could be updated to increase coverage affordability and care access. Payers and providers, it turns out, have very different ideas on where Congress should focus its efforts."
2.  Patient Lawsuits Crop Up in Response to Change Cyberattack
FierceHealthcare Link to more items from this source
Mar. 7, 2024
"Multiple suits have been filed in Minnesota as well as in Tennessee, with patients seeking a potential class action over the company's failure to protect their data. In one such suit ... a patient alleges that as of March 5 they had not been notified directly of the breach or as to the status of their own personal information."
3.  Employers Grapple with Reining in Costs for GLP-1s
FierceHealthcare Link to more items from this source
Nov. 30, 2023
"Employers ... see ultra-pricey drugs as key factors pushing up costs overall.... [F]ewer than half of large employers (42% of those with 500 or more employees) currently cover GLP-1 medications for treatment of obesity, although another 19% say they are considering it.... Employers and health plans also are looking at putting systems in place, such as prior authorization, that can better manage the cost around these drugs."
4.  Senate Votes to Reform PBMs
FierceHealthcare Link to more items from this source
Nov. 8, 2023
"[The] Better Mental Health Care, Lower-Cost Drugs and Extenders Act, when included with provisions from the Modernizing and Ensuring PBM Accountability (MEPA) Act from earlier this year, would introduce more transparency and regulation surrounding PBMs."
5.  New Value-Based Obesity Care Provider Launches
FierceHealthcare Link to more items from this source
Oct. 20, 2023
"Founded on the belief that obesity care will only transform healthcare if it is part of the system, Ilant plans to partner with employers and payers.... It starts with identifying those who would most likely see clinical and financial value from treatment through a proprietary engine that analyzes claims data ... Then, Ilant matches individuals to the treatment most likely to drive outcomes and value best for them through an evidence-based algorithm that accounts for medical, behavioral and social determinants of health factors."
6.  Payers Should Lean on PBMs as They Consider Coverage for Weight Loss Medications
FierceHealthcare Link to more items from this source
June 20, 2023
"[O]nly 25% of health plans cover weight loss medications with prior authorization and 10% to 15% of plans allow coverage without it.... [P]ayers should: [1] Review PBM formulary and utilization management systems to ensure that only clinically eligible patients get the drugs; [2] Negotiate lowest-net-cost PBM formulary changes to obtain the medications at the lowest prices; [3] Contract with a PBM that approves of manufacturer copay cards for non-specialty drugs, which can lower the cost burden on the payer."
7.  FTC Expands Probe Into Pharmacy Benefit Managers to GPOs
FierceHealthcare Link to more items from this source
May 17, 2023
"The [FTC] is expanding its probe into pharmacy benefit managers by issuing compulsory orders to two group purchasing organizations [GPOs] that negotiate rebates on behalf of PBMs.... Caremark, Express Scripts and Optum account for 80% of the PBM market, and all three are integrated with large national health plans: Aetna, Cigna and UnitedHealthcare, respectively. These massive companies also own GPOs, providers, data analytics and more."
8.  Senate Panel Advances PBM Bill That Would Ban Spread Pricing
FierceHealthcare Link to more items from this source
May 12, 2023
"The most contentious part of the PBM bill was a provision that would prevent these firms from deploying spread pricing models for their clients. In this model, a PBM would charge the insurer or plan sponsor more for a drug than it costs at the pharmacy and then pocket the difference.... [One provision] would direct the [DOL] to conduct a study into the fiduciary duties of PBMs that could be used to develop future legislation."
9.  How Payers Can Better Support Employers on Mental Health
FierceHealthcare Link to more items from this source
May 2, 2023
"[J]ust 31% [of employers surveyed] are satisfied with network access for behavioral health care services. In addition, only 34% of employers said that their behavioral health care directors accurately reflected the providers available to their plan members."
10.  UnitedHealthcare Launches Behavioral Health Coaching Program
FierceHealthcare Link to more items from this source
Jan. 20, 2023
"The offering is available as of Jan. 1 for 5 million fully insured members, and self-insured employers can also purchase the program as an employer benefit. Through the program, adults with symptoms of mild depression, stress and anxiety can access support for their mental health needs through virtual modules as well as one-on-one video conferences, phone calls or messaging with coaches."
11.  Walgreens Plots 'Aggressive' Strategy to Build Out Healthcare Services
FierceHealthcare Link to more items from this source
Nov. 21, 2022
"On the heels of several high-profile acquisitions, Walgreens aims to be a point of entry for consumers for healthcare services ranging from urgent care to specialty care and even in-home health."
12.  Manchin Reluctant to Add ACA Subsidy Extension to Spending Deal
FierceHealthcare Link to more items from this source
July 13, 2022
"Sen. Joe Manchin, D-West Virginia, said he is apprehensive about adding ACA enhanced subsidies to a narrow spending package that is expected to include a deal on prescription drug pricing reforms. The remarks ... come as the enhanced subsidies -- which helped spark record-level enrollment -- are going to expire after this year unless Congress acts."
13.  Supreme Court Declines to Consider Potential Fiduciary Duties of Pharmacy Benefit Managers
FierceHealthcare Link to more items from this source
June 28, 2022
"The Supreme Court declined to take up a lawsuit debating whether a pharmacy benefit manager has a fiduciary duty to lower drug prices, handing the industry a major win.... The decision comes amid increased scrutiny from the federal government and Congress on the PBM industry's role in the drug supply chain. The lawsuit focuses on whether a PBM has a fiduciary duty under [ERISA] to lower drug prices if it has the ability to do so." [Doe v. Express Scripts, No. 18-346 (2d Cir. Dec. 7, 2020; cert. pet. denied Jun. 27, 2022)]
14.  California Officials Hit Anthem Blue Cross with $1 Million Fine
FierceHealthcare Link to more items from this source
June 13, 2022
"The department issued a $750,000 fine for incorrectly applying office visits to some members' deductibles, which impacted more than 6,500 people between 2015 and 2020. The insurer will also pay a $360,000 fine for failing to mail out an explanation of benefits document to more than 363,000 members in 2019."
15.  Class Action Accuses Advocate Aurora Health of Suppressing Competition
FierceHealthcare Link to more items from this source
May 24, 2022
"Advocate Aurora Health has been hit with a class-action antitrust lawsuit alleging the system has used its market strength in Eastern Wisconsin to suppress competition and drive 'unreasonably high prices.' ... [T]he case was brought by Uriel Pharmacy, a Wisconsin-based pharmacy, and its self-funded health plan.... Among the anticompetitive strategies plaintiffs alleged the large nonprofit employed were 'all-or-nothing' clauses that require commercial health plans to include all Advocate Aurora facilities in their networks." [Uriel Pharmacy Health & Welfare Plan v. Advocate Aurora Health, Inc., No. 22-0610 (E.D. Wis. complaint filed May 24, 2022)]
16.  UnitedHealthcare Rolls Out New Virtual Physical Therapy Program
FierceHealthcare Link to more items from this source
May 5, 2022
"The program aims to offer 24/7, on-demand exercise feedback to eligible members with musculoskeletal conditions ... Members who are recovering from surgery or an injury will be asked to complete an assessment of current issues and will be referred to the program based on that assessment."
17.  Amazon Pharmacy Teams Up with Blue Plans to Roll Out Prescription Discount Savings Card
FierceHealthcare Link to more items from this source
Mar. 9, 2022
"Integrating this discount card pricing into the shopping experience lets eligible customers compare their co-pay or discount price upfront and then apply purchases for eligible medications to the out-of-pocket maximums and deductibles associated with their insurance plan[.]"
18.  HHS Renews COVID-19 Public Health Emergency Order for Another 90 Days
FierceHealthcare Link to more items from this source
Jan. 16, 2022
"By [renewing the Emergency Order] for another 90 days, [HHS] preserved major flexibilities for providers on telehealth and other waivers intended to help combat the virus ... The emergency ... also enables states and counties to waive certain requirements if they have issued their own emergencies."
19.  40% of Health Payments Tied to Alternative Payment Models in 2020
FierceHealthcare Link to more items from this source
Dec. 15, 2021
"Roughly 40% of U.S. healthcare payments were tied to alternative payment models (APMs) last year ... 38.2% of healthcare payments in 2019 and 40.9% of payments in 2020 were tied to an APM.... [T]he commercial insurance business had 32% of its dollars in an APM for 2019 and only slightly increased to 35% the next year."
20.  Hospitals' Infrequently Published Prices Suggest Substantial Variance in Radiology Service Charges to Commercial Payers
FierceHealthcare Link to more items from this source
Dec. 1, 2021
"Despite the threat of daily fines, hospitals have so far been slow to publish their prices online in accordance with a new federal regulation.... [New data suggest] roughly two-thirds of U.S. hospitals have not published commercial negotiated prices for at least one of the 13 radiology services designated as a common shoppable service by [CMS].... Further, the hospitals that did share their radiology service commercial negotiated prices appear to be all over the map, often setting price tags that varied by hundreds or thousands of dollars for certain imaging services."
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