Federal Judge Tosses Lobbying Group’s Lawsuit Challenging Medicare Drug Price Negotiations

A federal judge on Monday dismissed a lawsuit brought by a major pharmaceutical industry lobbying group and two other organizations that challenged Medicare’s new powers to negotiate prices for costly prescription medicines.

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In Fight Over Medicare Payments, the Hospital Lobby Shows Its Strength

In the battle to control health care costs, hospitals are deploying their political power to protect their bottom lines. The point of contention: For decades, Medicare has paid hospitals — including hospital-owned physician practices that may not be physically located in a hospital building — about double the rates it pays other doctors and facilities ...

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GoFundMe Has Become a Health Care Utility

GoFundMe started as a crowdfunding site for underwriting “ideas and dreams,” and, as GoFundMe’s co-founders, Andrew Ballester and Brad Damphousse, once put it, “for life’s important moments.” In the early years, it funded honeymoon trips, graduation gifts, and church missions to overseas hospitals in need. Now GoFundMe has become a go-to platform for patients trying ...

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Employee Benefits Help Provide A Solid Financial Foundation For Many U.S. Workers

Employee benefits help provide a solid financial foundation for many U.S. workers. Seven in 10 have at least one employer-provided insurance policy other than health insurance this year. “Insurance is the bread and butter of many financial advisors, but we must know what protections clients get at work to make sure our offerings are as ...

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House Panel Passes PBM Bill That Bans Spread Pricing, Only Allows A Flat Service Fee

The Delinking Revenue from Unfair Gouging (DRUG) Act would require pharmacy benefit managers that contract with a carrier offering federal health benefits plans to “de-link” the fees they charge insurers from the price of drugs.

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Senators Working On Legislation To Reform How Medicare Pays Physicians

A bipartisan group of senators announced Friday that it is working on new legislation for “long-term reforms” to physician payments under Medicare and other program changes. In a joint release, U.S. Sens. Catherine Cortez Masto, D-Nevada; Marsha Blackburn, R-Tennessee; John Barrasso, R-Wyoming; Debbie Stabenow, D-Michigan; Mark Warner, D-Virginia; and Minority Whip John Thune, R-South Dakota ...

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Health Insurers Balk At Proposed Medicare Advantage Rates

CVS Health and Centene executives say newly proposed Medicare Advantage rates for 2025 aren’t “sufficient” and hinted they could cut benefits if the federal government finalizes the rates as is. Why it matters: More than half of Medicare enrollees are in private Medicare Advantage plans. The specter of potential cuts to seniors’ health care benefits in an election ...

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Oscar Health Execs Weigh In On Future Of ACA Subsidies, Signal 2024 Profitability

Enrollment in individual market plans continues to grow, with a record high of 21.3 million people signing up for plans during the most recent open enrollment period. Much of that, however, is due to expanded premium subsidies, which launched during the pandemic and were extended through 2025. Officials at Oscar Health, which has reaped the ...

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Alleged Medical Supply Scam Could Cost Medicare $2 Billion

Patients have been reporting mysterious claims to Medicare for months of catheters they never ordered or received, which led to a massive spike in billing the accounts of more than 450,000 Medicare beneficiaries in 2023.

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‘Behind the Times’: Washington Tries to Catch Up With AI’s Use in Health Care

Lawmakers and regulators in Washington are starting to puzzle over how to regulate artificial intelligence in health care — and the AI industry thinks there’s a good chance they’ll mess it up. “It’s an incredibly daunting problem,” said Bob Wachter, the chair of the Department of Medicine at the University of California-San Francisco. “There’s a ...

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