Author: Scott Welch
Big health insurers said today that they will standardize the process for submitting requests for prior authorizations for coverage for many common procedures by Jan. 1, 2027. Managers of the standards effort will start by applying it to “medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services, including ...
After decades of selling insurance, Illinois-based broker John Jaggi had never seen anything like it. More than 80 of his customers who were enrolled in the same Medicare supplemental plan from the insurer Chubb got hit last August with a 45% increase. “In my 49 years of doing biz as a broker, I’ve never seen ...
Mark Cuban has a simple message for Congress: “Don’t be a wimp” and break up the healthcare industry’s biggest conglomerates to restore a competitive and efficient market. Speaking Tuesday at Politico’s Health Care Summit, the celebrity entrepreneur and co-founder of Mark Cuban Cost Plus Drugs Company, a direct-purchase marketplace for generic drugs, painted the picture ...
Employers and health plans continue to grapple with rising specialty drug costs as utilization growth and an expanding pipeline reshape benefit strategy, according to Pharmaceutical Strategies Group’s 13th annual Specialty Drug Benefits Report, which surveyed benefits leaders across employers, health plans and union-sponsored plans nationwide. Specialty drugs now account for more than half of total ...
GLP-1 drugs (glucagon-like peptide-1s) have exploded in popularity in recent years – initially as a way to control diabetes and then as tools for weight loss. Growing research suggests that these drugs – which include semaglutide and tirzepatide – potentially have benefits beyond weight loss, with stronger evidence for cardiovascular and kidney health. Even so, experts ...
Officials have failed to halt pervasive fraud in the hospice industry despite promises of reforms five years ago after learning of widespread corruption that targeted vulnerable patients. California authorities promised to crack down after a Times investigation in late 2020 revealed that a cohort of mostly older Americans was being targeted by unscrupulous providers who ...
A new executive order could eventually put psychedelic drugs on employer health plans’ prescription drug formularies. President Donald Trump signed an executive order Saturday that calls for “accelerating medical treatments for serious mental illness.” The order does not address matters such as health plan provider networks or health plan coverage for inpatient treatment for mental ...
Hospital and pharma groups have sharpened their spears for the rematch on 340B rebates. In comment letters submitted just ahead of a Monday deadline, the stakeholders weighed in on a contentious Trump administration pilot program that would overhaul drug discounts hospitals have received for the past 30 years to subsidize safety-net care. Rather than receive ...
House members got their first opportunity Thursday to grill Health and Human Services Secretary Robert F. Kennedy Jr., as he kicked off a marathon series of seven congressional hearings in seven days with back-to-back hearings in the Ways and Means and Appropriations Committees. In the two appearances, his first before Congress in 2026, Kennedy defended his record in leading the nation’s health agency as Democrats sought to push back ...
Employers, lawmakers, providers and more said the Department of Labor should quickly finalize disclosure mandates for the controversial drug middlemen.