Payer Policy Updates

The Federal Trade Commission has voted unanimously to put pharmacy benefit managers and drugmakers "on notice" about a new enforcement policy against illegal bribes and rebate schemes that can block patient access to competing lower-cost drugs. 

A bill was passed May 5 in the Hawaii State Legislature that would ban payers from applying "categorical cosmetic or blanket exclusions" for transgender individuals with prescribed gender confirmation treatments or procedures.

The Biden administration may look to require nursing homes to spend a majority of their Medicaid funding on direct care for residents and place a limit on using funds for operations, maintenance, capital improvements or profits, according to Kaiser Health…

In today’s world, convenience is a big element of our lifestyles. Why do healthcare benefits still seem so inconvenient?

Effective June 7, United Healthcare will require and Optum will manage prior authorization for the following outpatient radiation therapies:

Anthem Blue Cross is halting reimbursement of consultation services for its commercial plans. 

Blue Cross Blue Shield Healthcare Plan of Georgia plans to end its "avoidable emergency room" program on March 18.

UnitedHealthcare is rolling out a new obstetrical ultrasound policy for commercial members starting June 1, the payer said March 1.  

Georgia lawmakers are pitching a bill that would require families to be rescreened for possible eligibility if they lose their health insurance — a failsafe as states brace for an ACA enrollment cliff — according to the Augusta Chronicle. 

The FTC is requesting large, vertically-integrated players in the pharmacy benefit management industry share insights on their influence over drug pricing and access.