Payer
-
Wyden introduces price transparency bill targeting payers
The legislation stipulates that commercial insurers, as well as Medicare plans, provide an online tool and toll-free phone number for members to ask about cost of services and quality of providers.
By Shannon Muchmore • May 17, 2019 -
Express Scripts plans formulary for apps, medical devices
A list of digital health tools, including smartphone apps and software-enabled medical devices, is aimed at helping patients manage their health.
By Rebecca Pifer • May 17, 2019 -
JP Morgan expands footprint in healthcare payment game
Philadelphia-based InstaMed is particularly focused on eliminating paper from the labyrinthine healthcare payments system.
By Dana Elfin • May 17, 2019 -
CMS pulls back on key Part D proposals
While the final rule is seen as a win for pharmas and insurers, pharmacists and drug stores were not pleased.
By Samantha Liss • May 17, 2019 -
Small PBMs urge Congress: Don't kill rebates
An HHS rule that would eliminate Medicare and Medicaid drug rebates could have the unintended effect of raising patients' drug costs, one executive said.
By Samantha Liss • May 16, 2019 -
CMS targets PBM spread pricing
The agency is concerned the practice of charging pharmacists and health plans different prices for the same drugs is inflating costs and increasing the burden on taxpayers.
By Samantha Liss • May 16, 2019 -
Patients aren't sold on virtual health benefits, payers find
Health plans have been quick to embrace virtual care despite issues surrounding outcomes and access. A new survey from AHIP found most payers are facing unexpected challenges with patient adoption of virtual care.
By Tony Abraham • May 16, 2019 -
Federal lawmakers put forward competing proposals to ban surprise billing, with key difference
Both bills are bipartisan, but a draft bill in the House does not include arbitration, while the Senate plan does. The American Hospital Association supports such a provision, while the payer lobby group strictly opposes it.
By Shannon Muchmore • UPDATED: May 16, 2019 at 8:47 a.m. -
FTC commissioner: M&A outpacing agency funding
The regulator and other enforcers face multiple challenges in bringing enforcement actions against hospitals, FTC Commissioner Rebecca Kelly Slaughter said.
By Dana Elfin • May 15, 2019 -
Deep DiveOn the path to patients, NASH drugs may hit a payer roadblock
Wall Street estimates and clinical data suggest the earliest NASH drugs could come with limited efficacy but high price tags. Healthcare providers fear that won't sit well with payers.
By Jacob Bell • May 15, 2019 -
DOJ loses fight to limit CVS-Aetna testimony
The judge said it is "essential" to understand how pharmacy benefit management services affect Medicare Part D drug plans, which make up the scope of the merger settlement agreement.
By Samantha Liss • May 14, 2019 -
Cancer patients face sticker shock under short-term plans, study finds
Short-term insurance plans are facing scrutiny from Congress and patient advocates, who argue consumers are often unaware the plans offer only bare-bones coverage.
By Dana Elfin • May 14, 2019 -
As Trump wades in, states move on surprise billing
The political climate in Washington, where even historically bipartisan efforts move slowly at best, has left states to step in and do what they can.
By Shannon Muchmore • May 14, 2019 -
Kaiser Permanente's net income soars to $3.2B in Q1
The California-based integrated health system's financials are in line with a trend for non-profits after several years of expenses outstripping revenues.
By Samantha Liss • May 14, 2019 -
Uninsurance of children, parents inched back up in 2017, report finds
Both children and parents were more likely to be uninsured in states without Medicaid expansion, according to new research from the Urban Institute.
By Meg Bryant • May 13, 2019 -
Health plans improve on coverage, benefits but lag on costs, member expectations
Overall satisfaction is 245 points higher when members view their health plan as actively trying to lower their out-of-pocket costs and coordinate care, according to a J.D. Power study.
By Meg Bryant • May 13, 2019 -
Maryland's all-payer model shows limited effects for rural hospitals
The facilities had a 9% drop in outpatient visits but no change in inpatient utilization, readmission rate or emergency department visits, according to a new study in Health Services Research.
By Shannon Muchmore • May 13, 2019 -
DOJ moves to block certain witness testimony in CVS-Aetna merger review
The AMA has called economics and health experts Richard Scheffler and Neeraj Sood and antitrust legal expert Tim Greaney as witnesses in the case. The DOJ is seeking to block or limit the testimony of all three.
By Samantha Liss • May 13, 2019 -
Insured rate dips again, to 9.4% in 2018
About 1.1 million Americans lost insurance coverage in 2018, according to CDC's annual survey. That puts the total number of uninsured in the U.S. at 30.4 million.
By Tony Abraham • May 10, 2019 -
Payers not entitled to $12B in risk corridors payments, DOJ says
According to a claim filed by government officials Wednesday, the Trump administration doesn't have to shell out the funds because Congress required the Affordable Care Act to be budget-neutral.
By Rebecca Pifer • May 10, 2019 -
Private insurers pay hospitals more than double Medicare rates
The authors of a new RAND study looked at what commercial insurers pay as a percentage of Medicare prices, and found they increased from 235% of Medicare in 2015 to 241% in 2017.
By Samantha Liss • May 10, 2019 -
Massive Anthem hack engineered by China-based group, grand jury says
The payer's speed in notifying the government of the intrusion into its computer systems and cooperation in the investigation helped identify those responsible for the breaches.
By Dana Elfin • May 10, 2019 -
Ford enters NEMT space with national rollout of GoRide Health
The automotive giant is also partnering with the Greater Dayton Regional Transit Authority in Ohio to fill gaps in paratransit services.
By Meg Bryant • May 09, 2019 -
DOJ backs Oscar in antitrust case against Florida BCBS
Florida Blue Cross Blue Shield said no special weight should be given to the government's filing in the case and that "it is not even clear that the Government is entitled to submit a view on this matter at all."
By Samantha Liss • May 09, 2019 -
Trump prods Congress on surprise billing ban
The president called unexpected high-cost medical bills "one of the biggest concerns Americans have about healthcare."
By Shannon Muchmore • May 09, 2019
