Medicare Medicaid Category

Medicare & Medicaid

News articles in this section include actions by federal regulators like the CMS and HHS, as well as information on Medicare and state Medicaid coverage and benefits.

CMS Proposed Rule Aims To Shed Light On Prescription Drug Costs For Medicaid

The Biden administration issued a proposed rule Tuesday that aims to shed light on the price of prescription drugs covered by Medicaid. Under the proposal (PDF), pharmacy benefit managers, or pharmacy middlemen, that contract with Medicaid would have to disclose the prices they pay for medications in an effort to improve price transparency and pull the reins on ...

Read More

With Medicaid Redeterminations Underway, Many Are Unaware Of The Process: KFF

States were given the green light to begin Medicaid redeterminations in early April, yet many enrollees are still unaware of the process, according to a new survey. KFF analysts polled a representative sample of 3,605 people with a range of insurance types earlier this year and found that 65% of Medicaid members are unsure whether states can ...

Read More

Nevada Moves To Shift Medicaid Services To Statewide Managed Care

Through a budget committee vote in May, state lawmakers reversed Gov. Joe Lombardo’s proposed cuts to the state-run public health insurance option popularly called the “public option” — a measure passed during the 2021 legislative session that Lombardo called “bullshit” on the campaign trail. But as part of that meeting, in a move that went ...

Read More

Progressives Reintroduce ‘Medicare For All’ Bill

Key progressives in the House and Senate have revived the fight in Congress over "Medicare for All," a single-payer health system based on the Medicare program.

Read More

Senate Scrutinizes MA Payment Denials, Including Use Of Algorithms

Medicare Advantage plans’ use of third-party algorithms for coverage determinations is facing some scrutiny in the Senate. Lawmakers in a Wednesday hearing argued something must be done to pare back burdensome prior authorization requirements allowing payers to delay or deny medical care that would be covered under traditional Medicare — including the use of artificial intelligence ...

Read More

Ozempic Could Cost Medicare An Extra $26.8B Per Year If Coverage Were Expanded: Analysis

Patient demand for GLP-1 weight loss drugs is continuing to grow, and, if Medicare were to expand coverage to meet that demand, it could cost the program billions each year, according to a new analysis. Traditional Medicare does not currently cover these drugs, which include brand names like Novo Nordisk’s Ozempic and Wegovy, for weight loss. ...

Read More

Medicaid Unwinding And The Impact On Group And Individual Health Insurance Markets

The Families First Coronavirus Response Act (FFCRA), signed into law in March 2020, created the first major lifeline for Americans during the onset of the COVID-19 pandemic. It particularly addressed the immediate needs of working Americans who had suddenly lost their paychecks and/or their jobs – and their subsequent eligibilities for health insurance. Now that ...

Read More

Medicare Spending Could Increase $2 To $5 Billion If Coverage Expands For Lecanemab

Medicare annual spending on lecanemab's medication costs alone would place it among the most expensive Part B medications.

Read More

Drugmakers Set Strategy For Legal Fight Against US Pricing Regulation

Some of the world’s biggest drugmakers are laying legal groundwork to fight the U.S. plan to negotiate drug prices for its Medicare health coverage, including the argument that a ban against speaking about these talks violates constitutional rights, according to six industry sources. The Biden Administration’s signature drug pricing reform, part of the Inflation Reduction ...

Read More

First Wave of Nevada Medicaid Redeterminations Happening Now

As the state unwinds from the federal public health emergency, the Division of Welfare and Supportive Services (DWSS)  has begun the reevaluation of all Medicaid enrollments for the first time since 2020 during which you may lose coverage under Medicaid. In April, the first wave of recipients received their renewal packets in the mail. Those who ...

Read More