Promoting price transparency in health care is a policy approach with bi-partisan support in Congress and the public at large. This analysis examines the vast troves of price transparency data that payers are required and finds unlikely prices, inconsistencies, and other oddities that pose major challenges for efforts to use it to promote competition and…
The Justice Department’s years-long court battle to force UnitedHealth Group to return billions of dollars in alleged Medicare Advantage overpayments hit a major setback Monday when a special master ruled the government had failed to prove its case. In finding for UnitedHealth, Special Master Suzanne Segal found that the DOJ had not presented evidence to…
President Donald Trump’s firings at the Department of Health and Human Services included the entire office that sets federal poverty guidelines, which determine whether tens of millions of Americans are eligible for health programs such as Medicaid, food assistance, child care, and other services, former staff said. The small team, with technical data expertise, worked…
How best can you design an outcomes based agreement (OBA)? What are the key factors to consider? Project IDEATE is a “cross-disciplinary collaboration between National Health Service (NHS) Wales, industry and academia” with the aim to develop and refine OBA models. What were the key factors IDEATE considered for an OBA? Feasibility: Identify parameters to…
While more large employers are covering GLP-1 drugs for weight loss, KFF’s conversations with employers highlight concerns about the cost of these medications. Many of these employers have considered scaling back coverage of GLP-1 agonists for weight loss, or in some cases, employers are adding or strengthening coverage requirements.
Sue Sheridan’s baby boy, Cal, suffered brain damage from undetected jaundice in 1995. Helen Haskell’s 15-year-old son, Lewis, died after surgery in 2000 because weekend hospital staffers didn’t realize he was in shock. The episodes turned both women into advocates for patients and spurred research that made American health care safer. On April 1, the…
Medicare Part D spending on 10 diabetes drugs increased 364% between 2019 and 2023. The post Medicare Part D Spending on 10 Diabetes Drugs Hit $35.8B in 2023 appeared first on MedCity News.
Rep. Greg Murphy introduced a bill that would require out-of-pocket prescription drug spending to count toward patients’ deductibles and out-of-pocket maximums regardless of where the drugs are purchased. The post New Bill Seeks to Lower Out-of-Pocket Drug Costs appeared first on MedCity News.
In the 39 states that are adopting or may adopt the high unemployment hardship exception, about 1.4 million or 7.5% of Medicaid expansion enrollees live in one of the 133 counties that currently meet the high-unemployment criteria.
Vertex Pharmaceuticals is known for its cystic fibrosis drugs, but the company aims to diversify with a pipeline that reaches more therapeutic areas. CEO Reshma Kewalramani explained Vertex’s strategy during the World Medical Innovation Forum in Boston. The post Pain Meds, Cell Therapies & More: Vertex Pharma CEO Talks About What’s Next After Cystic Fibrosis…