Author: Scott Welch
The Federal Trade Commission released a critical report detailing how pharmacy benefit managers—like CVS Health’s Caremark, Cigna’s Express Scripts and UnitedHealth’s Group OptumRx, which manage 80% of American prescriptions—could be driving up the costs of some medications and favoring their own pharmacies at the expense of independent drug stores.
The Federal Trade Commission staff is having trouble getting information from the big pharmacy benefit managers, but it believes that the big PBMs may have too "outsized influence" over the U.S. pharmaceutical system and may be steering prescription revenue to their own pharmacies.
The Wall Street Journal has added to the pressure on Medicare Advantage plan issuers by publishing its own analysis of how the issuers score their enrollees' health.
The Federal Trade Commission is preparing a lawsuit against the three largest drug intermediaries over their use of rebates for insulin and other drugs, according to a person familiar with the probe. The agency has been investigating whether the rebate practices of insulin manufacturers and three pharmacy benefit managers — units of CVS Health Corp., ...
The sweeping payment rule also solidifies continuous eligibility requirements for children in Medicaid and CHIP, and holds hospitals to higher obstetric care delivery standards.
Congress will have to decide soon whether to continue a big, temporary increase in premium tax credit subsidies for Affordable Care Act public exchange plan coverage. If it lapses could increase enrollment in employer-sponsored coverage by millions.
A proposed rule that would require the nation's most critical industries to more quickly report cyberattacks is raising the ire of the health care industry, which claims the new directives could actually hinder its response in a crisis.
Private insurance firms running Medicare Advantage programs have been overcharging the federal government billions of dollars by making patients look sicker than they really are, according to a report in The Wall Street Journal on Monday.
The federal agency that oversees HealthCare.gov now expects to work with about 90,000 agents and brokers each year, up from 54,000 in 2021.
A landmark Supreme Court decision that reins in federal agencies’ authority is expected to hold dramatic consequences for the nation’s healthcare system, calling into question government rules on anything from consumer protections for patients to drug safety to nursing home care. The June 28 decision overturns a 1984 precedent that said courts should give deference ...