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 ...

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Subcommittee Hearing Reveals Plenty Of Targets, But Little Consensus, For Lawmakers’ Healthcare Consolidation Reforms

House members participating in a Wednesday afternoon subcommittee hearing were in broad, bipartisan agreement that consolidation and other anticompetitive practices are prevalent across the healthcare industry and drive untenable costs for patients and the government. Based on their grab bag of witness questions and finger-pointing, however, it’s still up for debate which offending camp—pharmacy benefit ...

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FTC Signals Tougher Rules For Health Companies’ Use Of Data

The Federal Trade Commission issued a warning Thursday about companies’ use of consumers’ biometric information such as facial recognition technology, saying it raises “significant consumer privacy and data security concerns.” Why it matters: The warning comes as a growing number of companies amass data based on individuals’ physiological features which could be used to infer consumers’ health or ...

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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. ...

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WHO Urges Caution With Healthcare AI Deployments

As artificial intelligence deployments increase in pace and scope in healthcare organizations around the globe, the World Health Organization this week issued a plea for vigilance and deliberation when it comes to how AI and machine learning models are put to use. WHY IT MATTERS The WHO called for “caution to be exercised” in how ...

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Are US Prescription Drug Prices 10 Times Those of Other Nations? Only Sometimes

Sen. Bernie Sanders (I-Vt.), whether in Congress or as a presidential candidate, has always taken strong positions against the high cost of prescription drugs. Since becoming the chair of the influential Senate Health, Education, Labor and Pensions Committee this year, he’s made lowering drug costs a top priority. It’s therefore not surprising that the senator would, during a ...

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