Specialty Pharmacy Costs, Mental Health Are Top Employer Concerns. Here’s Why

Self-insured employers view the cost of specialty drugs as a major challenge in providing health benefits, according to a survey released yesterday by the Midwest Business Group on Health (MBGH). Cheryl Larson, MBGH’s president and CEO, told Fierce Healthcare that “the new million-dollar treatments approved by the FDA; 30 of our employers said that this is a ...

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Eli Lilly To Cut Insulin Prices, Cap Costs At $35 For Many People With Diabetes

Eli Lilly announced Wednesday a series of price cuts that would lower the price of the most commonly used forms of its insulin 70% and said it will automatically cap out-of-pocket insulin costs at $35 for people who have private insurance and use participating pharmacies.

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CMS Says Surprise Billing Arbitration Can Resume For Some Disputes — Others Remain On Pause

Dive Brief: Arbiters can resume resolving payment disputes between providers and payers involving cases in which care was delivered prior to Oct. 25, the CMS said Friday. However, the arbitration process to is still on hold for disputes regarding services delivered on or after that date, following a federal judge’s decision earlier this month. The CMS is ...

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Advocates, Lawmakers Warn That Biden Telehealth Rule Will Worsen Opioid Crisis

Doctors, public health experts, and even Democratic members of Congress are sounding the alarm on a new Biden administration proposal to restrict access to a key addiction-treatment medication. The proposal would curtail access via telehealth to buprenorphine, a common and highly effective drug used to treat opioid use disorder. While doctors can currently give out both new ...

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Medicare Advantage Yielded Strongest Margins For Insurers, Study Finds

Health insurers’ margins in Medicare Advantage were more than double those seen in other markets in 2021, reinforcing the way the program can produce strong financial returns for plans, a new Kaiser Family Foundation analysis shows. Why it matters: Private Medicare plans are expected to draw more than half of eligible beneficiaries this year. But government payments to ...

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COVID-19 States Of Emergency Are Ending. Here’s What’s Changing.

California’s state of emergency declaration, a response to the COVID-19 pandemic, ends on February 28. The federal state of emergency also ends this spring, on May 11.

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Study: Why Employers Expect To Be Offering Health Coverage For The Long Haul

Despite rising costs, employers will continue to offer healthcare coverage to their workers, and they don’t see that ending anytime soon, if ever, according to a report by the Employee Benefit Research Institute (EBRI).

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Thousands In Southern California Are Expected To Lose Out On Medi-Cal In April

As pandemic-era policies come to an end, tens of thousands of Southern Californians are expected to lose out on Medi-Cal, California’s Medicaid program, come April. Experts estimate about 330,000 people in Los Angeles County and approximately 160,000 in Orange County will be ineligible for Medi-Cal in April when states resume the redetermination process. The number of ...

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Prices Up On Hundreds Of Drugs In January

As reported by Reuters, an analysis by the health care research firm 3 Axis Advisors found a roster of drugmakers raised prices in the U.S. last month on more than 350 drugs. The manufacturers include major industry players like AstraZeneca, Bristol Myers Squibb, GlaxoSmithKline (GSK), Pfizer, and Sanofi.

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Price Transparency Data From Hospitals Is ‘Challenging, If Not Impossible’ To Parse, Report Says

Despite federal regulations on price transparency, many people still have a hard time comparing costs between hospitals. According to a new analysis from the Kaiser Family Foundation, which uses data assembled by health care software company Turquoise Health, there are limited mandated standards for how hospitals should classify and share prices, and a lack of regulation which ...

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