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Industry Updates

This broad category includes articles concerning health insurance costs, carrier and health plan news, changing benefits technology, and surveys by the Kaiser Family Foundation and others on employee benefits.

U.S. Sues Rite Aid For Missing Opioid Red Flags

The U.S. government on Monday sued Rite Aid Corp (RAD.N), accusing the pharmacy chain of missing “red flags” as it illegally filled hundreds of thousands of prescriptions for controlled substances, including opioids. In a complaint filed in Cleveland federal court, the Department of Justice said Rite Aid repeatedly filled prescriptions from May 2014 to June 2019 ...

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FDA’s Robert Califf Calls On Insurers To Help Providers Participate In Critical Clinical Drug Trials

Insurers must do more to help providers participate in clinical trials that can confirm the effectiveness of drugs granted accelerated approval, Food and Drug Administration Commissioner Robert Califf, M.D., told a room full of payer executives Thursday. Califf spoke about how to improve the accelerated approval process during a session at the AHIP 2023 Medicare, ...

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EBRI, Commonwealth Study Finds That Support For Employer-Based Health Benefits Remains Strong

When the Affordable Care Act (ACA) was passed in 2010, one of the main concerns — which was often used to argue against passage of the health care reform bill — was that Americans would stop enrolling in employer-based plans and instead jump to the government-controlled ACA marketplace.

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Nearly 1 In 3 Patients Don’t See Primary Care Doc

Nearly 30% of all patients who received medical services between 2016 and 2022 did not see a primary care physician, a FAIR Health analysis provided first to Axios shows. Why it matters: Primary care providers are supposed to manage patients’ day-to-day health needs and provide preventative care, and evidence shows it can drive down costs and improve outcomes. ...

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Novo Nordisk Plans Price Cuts For Several Insulins

Another major insulin maker has promised steep price cuts, as pressure grows on drugmakers and insurers to trim the cost of a medication that millions of Americans need. Novo Nordisk said Tuesday that it will slash some of its U.S. insulin prices up to 75% starting next year. The announcement comes less than two weeks ...

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Here Are The Top Health Items In Biden’s New Fiscal 2024 Proposed Budget

President Joe Biden released his budget for the 2024 federal fiscal year, outlining new investments to expand Medicaid, drug price reforms and other new policies. While the budget itself is unlikely to get enacted by a divided Congress, the document does outline key health priorities for the administration.

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CAA 2022 Prescription Drug Data Collection (RxDC) Requirements For Health Plans – Due June 1st, 2023

The Consolidated Appropriations Act (CAA) Rx Data Collection (RxDC) component requires health plans/issuers to produce and file reports on prescription drug and health care spending for the 2022 calendar year by 6/1/2023. These reports are due annually and will be due by June 1st each year thereafter. The Centers for Medicare & Medicaid Services (CMS) has released a RxDC Reporting Instructions Guide to help facilitate reporting.

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The Word & Brown Companies Achieve HITRUST Risk-based, Two-year Certification to Manage Risk, Improve Security Posture, and Meet Compliance Requirements

The Word & Brown Companies today announced that key operating systems in use by Word & Brown® General Agency and CHOICE Administrators® have earned Certified status for information security by HITRUST.

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CMS Proposes Prior Authorization Rule Changes For Health Plans

When Paula Chestnut needed hip replacement surgery last year, a pre-operative X-ray found irregularities in her chest. As a smoker for 40 years, Chestnut was at high risk for lung cancer. A specialist in Los Angeles recommended the 67-year-old undergo an MRI, a high-resolution image that could help spot the disease. But her MRI appointment ...

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Senators Urge CMS To Close ‘Loopholes’ In Payer Price Transparency Rule

Two top senators are urging the Biden administration to address “loopholes” that they said allow insurers to skirt price transparency requirements. Sens. Maggie Hassan, D-New Hampshire, and Mike Braun, R-Indiana, wrote in a letter (PDF) to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure that the agency should update its regulations to “ensure that there is ...

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