Payer
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UnitedHealthcare delays controversial ER policy following backlash
After protests from providers and medical societies, the biggest private payer is delaying the start of the policy until at least the end of the COVID-19 national emergency. But hospitals say it should be scrapped for good.
By Rebecca Pifer • UPDATED: June 11, 2021 at 10:57 a.m. -
Nevada becomes second state with public health insurance option with governor OK
Washington is the only other state to enact such an insurance plan, which went live this year. Coverage under Nevada’s plan won’t begin until 2026.
By Hailey Mensik • June 10, 2021 -
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TrendlineConsumerism
Some stablished players have paying more attention to patient experience, rolling out improvements such as same-day appointments, apps the help explain coverage or health conditions and better integration with email and text messaging.
By Healthcare Dive staff -
Retrieved from C-SPAN on February 23, 2021
HHS warns providers, insurers COVID-19 testing must be free for patients
The American Clinical Laboratory Association, which has members including Quest Diagnostics and LabCorp, has complained that guidance on the topic had only served to muddy what it saw as clear congressional mandates.
By Greg Slabodkin • June 10, 2021 -
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Industry awaits Supreme Court decision on ACA case
A ruling on the fate of the landmark law could come as early as Thursday morning.
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A first-of-its-kind Alzheimer's drug raises heavy questions around who will and won't get it
Biogen priced its newly approved medicine Aduhelm at an average cost of $56,000 a year. Cigna, which estimates out-of-pocket costs may hit $10,000, is working on a value-based payment agreement with the drugmaker.
By Jacob Bell • June 09, 2021 -
One Medical
One Medical and Iora serve radically different populations. Here's why the $2.1B tie-up might make sense.
With its multibillion-dollar acquisition of value-based Iora, One Medical is betting big on capturing longitudinal care and the profitability of risk.
By Rebecca Pifer • June 09, 2021 -
Courtesy of Walmart
Walmart, Amazon simultaneously add prescription discounts to membership perks
Walmart+ members can access some medications at zero cost and thousands of others at discounts of up to 85%. A day later, reports surfaced that Amazon is offering prescriptions for Prime members at the equivalent of $1 per month.
By Ben Unglesbee • June 09, 2021 -
Hospital lobby urges UnitedHealthcare to reverse 'dangerous' ER policy
AHA sent a letter asking the nation's largest commercial insurer to abandon a policy that denies ER visits if they are later deemed unnecessary. The policy will lead to a chilling effect on members seeking ER care, the group said.
By Samantha Liss • June 09, 2021 -
Novo Nordisk
Novo keeps price in line with FDA approval of second obesity shot
The Danish company is setting the drug's list price at $1,297 a month, equivalent to its daily obesity drug Saxenda, increasing the chances insurers will cover it on a similar basis.
By Jonathan Gardner • June 07, 2021 -
Permission granted by Biogen
Deep DiveIn historic move, FDA approves closely watched, controversial Alzheimer's drug
With the decision, the agency cleared the way for what many predict will become a lucrative and highly sought-after option — though fierce debate continues over whether Biogen's aducanumab actually benefits patients.
By Jacob Bell • UPDATED: June 7, 2021 at 4:37 p.m. -
Courtesy of One Medical
One Medical buying Medicare-focused Iora in $2.1B deal
The acquisition by the Google-backed primary care chain aligns two players in the value-based care movement, which eschews traditional payer-provider arrangements in favor of a concierge membership model.
By Shannon Muchmore • June 07, 2021 -
Asawin Klabma via Getty Images
Sponsored by UbiquityBuilding a social determinants of health strategy: data is the key
For managed-care plans focused on improving population health and reducing overall costs, the goal has to be on prevention, not just treatment.
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UnitedHealthcare to crack down on ER visits, potentially exposing patients to bigger bills
If the largest private payer finds the trip was not an emergency, the visit will be "subject to no coverage or limited coverage," the provider alert states. Anthem faced backlash for a similar policy several years ago.
By Samantha Liss • June 04, 2021 -
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CMMI's Fowler: More mandatory payment models likely
"I recognize those come with their own set of disadvantages ... But I support this direction," CMMI head Elizabeth Fowler said Thursday.
By Rebecca Pifer • June 03, 2021 -
Medicaid insurers at heart of Nevada public option plan
The state will bid out the business to private insurance carriers instead of doing the work in-house. Medicaid managed care organizations Centene, UnitedHealthcare and Anthem will be required to submit a bid.
By Samantha Liss • June 02, 2021 -
Courtesy of EQRx
EQRx readies a lower-cost alternative to pricey cancer immunotherapies
The biotech and its partner CStone disclosed Phase 3 results in lung cancer that support approval plans for a drug similar to treatments like Merck's Keytruda, but would be priced at a fraction of the cost.
By Ben Fidler • June 02, 2021 -
Fotolia
ACLA appeals dismissal of PAMA lawsuit, pushes legislative fixes
The lab trade group for Quest, LabCorp and others argues the Protecting Access to Medicare Act is a case of "harmful regulatory overreach" that forces an "unsustainable reimbursement model" on its members.
By Nick Paul Taylor • June 02, 2021 -
Privately insured face worse access, higher costs than those in public plans: JAMA report
The new research comes roughly a week after Democrats revived efforts to draft legislation enacting a Medicare-like public option, a bid to reduce the nation's uninsured rate and lower healthcare costs.
By Rebecca Pifer • June 01, 2021 -
National Cancer Institute, NIH
In first, FDA approves KRAS-blocking cancer drug from Amgen
Lumakras is the first drug proven effective in targeting the KRAS gene, which is often mutated in lung, colon and pancreatic cancers. Amgen will charge $17,900 per month for Lumakras at list price, which doesn't account for rebates or discounts that may be offered to insurers.
By Ned Pagliarulo • June 01, 2021 -
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Family healthcare costs decreased last year for first time in Milliman report's 16-year history
However, the trend is not expected to continue into 2021. Costs are predicted to jump nearly 9% to $28,256 next year for a family of four.
By Samantha Liss • May 28, 2021 -
Senate confirms Chiquita Brooks-LaSure as head of CMS
Industry groups cheered her confirmation, saying Brooks-LaSure's policy know-how and experience managing insurance programs should help increase equitable access to affordable care in the U.S.
By Rebecca Pifer • May 25, 2021 -
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ICER, vocal critic of drug company pricing, turns scrutiny to insurers
The watchdog group plans to examine how cost sharing can hurt access to care, but it won't assess some of the most controversial insurer practices.
By Jonathan Gardner • May 25, 2021 -
Anthem wrongly received $3.4M in MA overpayments, OIG says
The insurer is the latest to face allegations of receiving Medicare Advantage overpayments tied to patients who were inaccurately identified as part of a high-risk group.
By Samantha Liss • May 25, 2021 -
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After Haven flop, JPMorgan Chase unveils solo healthcare venture
Morgan Health, somewhat of a successor to the defunct collaboration with Amazon and Berkshire Hathaway, comes armed with $250 million to invest in innovations in employer coverage and advancements in health equity.
By Dan Ennis , Rebecca Pifer • May 21, 2021 -
Anthem, Epic launch data-sharing partnership
The collaboration will integrate Epic's payer platform into Anthem's operating system, in a bid to streamline administrative processes like electronic prior authorization while harnessing more real-time data on patient behaviors.
By Shannon Muchmore , Rebecca Pifer • May 20, 2021
