More than 10,000 people have enrolled in Nevada’s new public option health plans, which debuted last fall with the expectation that they would bring lower prices to the health insurance market. Those preliminary numbers from the open enrollment period that ended in January are less than a third of what state officials had projected. Nevada…
Less than 36 hours before his wife was scheduled to undergo major surgery, New York Times personal finance columnist Ron Lieber got an unwelcome letter from his family’s insurance plan: It was denying prior authorization for the procedure. With no time to lodge an appeal, Lieber and his wife decided to proceed and bet on…
After years of legislative debate, Congress has formally codified PBM reform into federal statute. Tucked within the Consolidated Appropriations Act, 2026 (H.R. 7148), signed on February 3, 2026 are structural mandates that will reshape Pharmacy Benefit Manager (PBM) operations in Medicare Part D and the commercial sector by 2028. The legislation targets three primary pillars:…
Solera Health has launched a behavioral health network that connects members to partners Calm Health and Lyra Health for digital mental health, coaching and therapy services. The post Solera Health Launches Behavioral Health Network with Calm and Lyra appeared first on MedCity News.
CSL Limited retain rights to clazakizumab in end-stage kidney disease. Eli Lilly gets rights to the the IL-6-blocking antibody in other indications that could put it in competition with Novo Nordisk and Novartis. The post Eli Lilly Joins Chase for Hot Inflammation Target, Paying $100M for Rights to CSL Drug appeared first on MedCity News.
This brief describes the Managed Care Program Annual Report (MCPAR), a relatively new, comprehensive report on state Medicaid managed care programs that includes plan-level data. It is used with other managed care reports to improve state and federal managed care program monitoring, oversight, and transparency.
Healthcare leaders must resist using AI as a substitute for staffing. Instead, invest in workforce optimization technology that empowers nurses, creates flexible pathways, and addresses the systemic issues driving burnout. The post Healthcare’s AI Obsession Is Missing the Point on Nursing Shortages appeared first on MedCity News.
Here are some of the structural and strategic causes behind that failure rate, and ways to improve launch outcomes. The post Addressing the 58% Launch Failure Rate: Accelerating Market Access Through Intelligent Decision-Making appeared first on MedCity News.
It’s the rare policy question that unites Republican Gov. Ron DeSantis of Florida and the Democratic-led Maryland government against President Donald Trump and Gov. Gavin Newsom of California: How should health insurers use AI? Regulating artificial intelligence, especially its use by health insurers, is becoming a politically divisive topic, and it’s scrambling traditional partisan lines….
Wyoming officials say they have a plan to make five years of upcoming grants from a new $50 billion federal rural health program last “forever.” The state could tackle rural health issues long into the future by investing its awards from the Rural Health Transformation Program, the director of Wyoming’s health department, Stefan Johansson, told…