How does formulary restrictions impact health outcomes for patients with multiple sclerosis (MS)? To answer this question, Blaylock, Van Nuys and Joyce (2025) use data 100% Medicare claims data from 2018-2022 covering patients with both prescription drug plans (PDPs) and Medicare Advantage Prescription Drug plans (MA-PDs). Individuals were categorized as above vs. below average formulary…
Amy Frank dijo que pasó 17 horas al teléfono durante casi tres semanas, rebotando entre su aseguradora y el sistema hospitalario local, para asegurarse de que el plan de salud cubriera la atención que su esposo necesitaba después de una cirugía. Muchas de sus llamadas no pasaron de la música en espera. Cuando lograba comunicarse,…
Out of the 476 ACOs that participated in the Medicare Shared Savings Program in 2024, 75% earned $4.1 billion in performance payments, CMS reported. The post CMS: ACOs in Shared Savings Program Saved Medicare $2.4B in 2024 appeared first on MedCity News.
“So far AI in health care is being used to drive existing profits on workflows and increase revenue per event that patients in the end have to pay for. That’s not a win for anyone long term!” Included Health’s CEO Owen Tripp dives into the present and future use of AI, LLMs, patient self-triage and…
Novartis, which already has experience with RNA interference therapies, is now turning to this modality as a potential way to treat Parkinson’s disease. The pharmaceutical giant is licensing rights to an Arrowhead Pharmaceuticals RNAi therapy designed to inhibit production of alpha synuclein, a protein associated with Parkinson’s progression. The post Novartis Tries Again in Parkinson’s,…
AI can now flag where patients are getting stuck — from enrollment delays to dropped calls — while also enabling new, compliant ways to analyze these interactions at scale. But surfacing the issue is just the first step. The post Pharma Is Reclaiming Control Over Patient Experience. What Does It Mean For The Hub Model?…
Symptoms often get labeled as anxiety, chronic fatigue, early neurodegeneration, IBS, or fibromyalgia. How to prevent the root cause — mold exposure — from going unrecognized. The post My Mold Illness Nearly Broke Me — Let’s Ensure Others Get the Care They Deserve appeared first on MedCity News.
LISTEN: Measles. Chickenpox. Meningitis. Many vaccines can run more than $100 a dose out-of-pocket. Jackie Fortiér tells WAMU’s “Health Hub” how Trump administration changes to the federal vaccine guidelines could make some routine shots too expensive for families. Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist, replaced the members of…
Amy Frank said it took 17 hours on the phone over nearly three weeks, bouncing between her insurer and her local hospital system, to make sure her plan would cover her husband’s post-surgery care. Many of her calls never got past the hold music. When they did, the hospital told her to call her insurer….
John McGing couldn’t reach a human. That might be business-as-usual in this economy, but it wasn’t business; he had called the Social Security Administration, where the questions often aren’t generic and the callers tend to be older, disabled, or otherwise vulnerable Americans. McGing, calling on behalf of his son, had an in-the-weeds question: how to…