2+ hour, 1+ min ago   (365+ words) A new study published in JAMA puts hard numbers behind something patients and doctors have been telling me for years: getting a prescription filled increasingly means running an obstacle course of denials, prior authorization forms, and step therapy requirements — and…...

18+ hour, 49+ min ago   (518+ words) shedding more than 1.5 million of its health plan enrollees and spending a considerably smaller percentage of its customers’ premiums paying claims than it did in the same quarter last year. The company also continued to take advantage of being able…...

1+ day, 20+ hour ago   (547+ words) A Senate Armed Services Subcommittee on Personnel hearing last week highlighted growing concerns about the Pentagon’s relationship with Cigna’s Express Scripts, the pharmacy benefit manager (PBM) that oversees the military’s TRICARE pharmacy program. During the hearing, Sen. Elizabeth Warren (D-Mass.)…...

6+ day, 23+ hour ago   (969+ words) Red Oak is not unusual. It is part of a pattern: the quiet unwinding of behavioral-health practices that UnitedHealth’s Optum acquired only a few years earlier, often with the same abrupt letter, the same generic referral, and the same corporate…...

1+ week, 6+ day ago   (613+ words) Health insurers have a new talking point – based on a new “study” by the giant health insurance conglomerate Elevance Health – and it goes something like this: Doctors are exploiting the No Surprises Act’s (NSA) arbitration process to extract outrageous payments,…...

2+ week, 5+ day ago   (373+ words) Private insurance companies use prior authorization extensively in the Medicare Advantage plans they own and operate, resulting in delays and denials of care that have been documented in numerous reports by government watchdog agencies. Until the WISeR program was launched…...

2+ week, 6+ day ago   (249+ words) Elevance Health, one of the nation’s biggest health insurance conglomerates, wired more than $342 million to the Centers for Medicare & Medicaid Services a few weeks ago after the agency threatened to suspend enrollment in the company’s Medicare Advantage plans over what…...

3+ week, 20+ hour ago   (1004+ words) Most Americans are familiar with UnitedHealth, the largest private health insurer in America – if not because the corporate giant provides their medical coverage, then because of the massive publicity when the CEO of its key subsidiary was assassinated on a…...

3+ week, 5+ day ago   (210+ words) Back in October, I warned that these plans (often called short-term, limited-duration insurance plans, or STLDIs) were poised for a comeback as enhanced Affordable Care Act subsidies expired and millions of Americans faced sharp premium increases. Well, now these plans…...

1+ mon, 2+ day ago   (371+ words) Only a few months after Congress enacted some of the most significant federal reforms to date of the business practices oft pharmacy benefit managers, the PBM industry’s chief lobbying group says it has launched the biggest advertising campaign in its…...