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Pharmacists to Express Scripts: Actions speak louder than words
The National Community Pharmacists Association is skeptical new reimbursement policies from Express Scripts will amount to meaningful change for independent pharmacies. -
OIG: Humana received $27.3M in Medicare Advantage overpayments
HumanaChoice received an estimated $27.3 million in overpayments in 2015 and 2016, according to an audit from HHS' Office of Inspector General. -
UnitedHealth Group's 5 highest-paid executives
UnitedHealth Group CEO Andrew Witty was paid $20.9 million in total compensation in 2022, according to regulatory filings published April 21. -
Manufacturers lobbying Congress for Medicare coverage of new weight loss drugs
Drug manufacturers are lobbying for Medicare to cover the cost of expensive new drugs meant for treating obesity, The Wall Street Journal reported April 24. -
Highest-paid payer CEOs in 2022
Molina Healthcare CEO Joseph Zubretsky received the largest compensation package among the most prominent payer CEOs in 2022, according to regulatory filings published with the Securities and Exchange Commission. -
Unfiltered: The insurance denials most frustrating to physicians
Hundreds of physicians across the nation have taken to Twitter to share their thoughts on a simple question: What is the insurance denial in your specialty that frustrates you and your patients the most? -
House Republicans unveil Medicaid work requirement plan
House Republicans have included Medicaid work requirement proposals in their bill to raise the debt ceiling into next year, The Washington Post reported April 20. -
'Systemic failures' at Anthem have left $300M in unpaid claims, New Hampshire hospitals say
Hospitals across New Hampshire say Anthem's operations and overall performance in the state has left providers with $300 million in unprocessed claims and created "universal dissatisfaction" with the Elevance Health subsidiary. -
Elevance Health eyes expanding post-acute care business
Elevance Health is planning to expand its post-acute care management program, a move the company's leaders say will contribute to the payer's growth in 2023. -
Express Scripts upping reimbursements for rural, independent pharmacies
Express Scripts, a pharmaceutical benefit manager owned by the Cigna Group, is increasing reimbursement rates for some independent pharmacies in rural areas. -
Optum in the headlines: 8 updates
From posting double-digit growth in the first quarter of 2023 to acquiring a New York.-based multispecialty physician group, here are eight headlines about Optum that Becker's has reported since March 22. -
Medicare drug pricing proposal not true negotiation, pharma group says
Pharmaceutical Research and Manufacturers of America says CMS' guidance for Medicare drug price negotiation disadvantages manufacturers and will hurt innovation. -
Elevance Health does not cover weight loss drugs in most cases, CFO says
Elevance Health, formerly known as Anthem, does not cover GLP-1 drugs prescribed only for weight loss, except in states that require coverage of the drugs by law. -
Independence Blue Cross, Penn Medicine piloting program to cut prior authorizations
Independence Blue Cross and Philadelphia-based Penn Medicine are piloting a program that will allow qualifying physicians to skip prior authorization approvals needed for ultrasounds, CT scans and PET scans, The Philadelphia Inquirer reported April 18. -
Where Medicare Advantage plans can address disparities, per CMS
Medicare Advantage enrollees across racial and ethnic groups have similar responses to self-reported patient experience measures, but disparities persist in clinical outcomes. -
Anthem BCBS, Valley Health settle reimbursement dispute
Anthem Blue Cross Blue Shield and Valley Health have settled a dispute over claims reimbursement out of court. -
Biden administration to roll out free COVID-19 vaccines, treatments for uninsured
The White House plans to keep COVID-19 vaccines and treatments free for uninsured individuals through 2024, Politico reported April 18. -
What's next for payer price transparency: 5 things to know
Payers have been required to post all of their negotiated rates in publicly available files since July 2022, and most have done so, according to Turquoise Health. -
48 payers with perfect price transparency scores, per Turquoise Health
Dozens of payers have posted accessible and complete price transparency data since requirements for payers to publish negotiated rates took effect, according to Turquoise Health. -
It takes a village: Improving healthcare means sharing data across the ecosystem
Effective patient care requires coordination across many different players, ranging from primary care physicians to hospitals, rehab facilities, health plans and more. Unfortunately, data sharing among these disparate stakeholders can often be challenging.
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