Independent Health is joining MVP Health Care, another nonprofit insurer based in New York. Sharing assets is one reason for the member substitution agreement, but there is another opportunity for the organizations. Pharmacy Benefit Dimensions is a subsidiary of Independent…
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Connecticut Gov. Ned Lamont signed a bill Nov. 18 requiring insurance companies to extend autism behavioral therapy coverage to include individuals up to 26 years old. Behavioral therapy for autism can include applied behavior analysis and cognitive behavioral therapy, along…
More and more payers and employers have been getting on board with surgical alternatives to GLP-1s for weight loss. A 2024 survey found most employer-sponsored plans covered these procedures, and covering GLP-1s for diabetes and obesity was much less likely.…
Cigna Healthcare has partnered with Magic Johnson to produce “Magic Sounds,” a six-track album designed to boost mental health, according to a news release. Cigna pulled from peer-reviewed research and worked with clinical experts and music therapists to determine tempo,…
Medicare will begin covering weight-loss drugs in 2026 for the first time under a pricing agreement announced by the White House, according to a Nov. 6 press release. The agreements with Eli Lilly and Novo Nordisk apply most-favored-nation pricing to…
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Amid a government shutdown over ACA subsidies and contentious “Make America Healthy Again” moves, Becker’s checked in with behavioral health payer and managed care provider Magellan Health’s CEO, Caroline Carney, MD, to glean her insights on how her organization is…
Many Medicare Advantage and Medicaid managed care plans lack robust behavioral health networks, according to an October brief from the HHS Office of the Inspector General. The OIG analyzed four MA plans and two Medicaid managed care plans across 10…
Even those with employer-sponsored health insurance struggle with accessing mental healthcare, according to a survey from the Employee Benefit Research Institute and Path Forward. The survey encompassed over 3,100 workers with employer-sponsored health coverage. Here are five numbers depicting how…
Total risk adjustment payments in individual and small group insurance plans increased modestly in 2024, according to new data from CMS. The agency published its annual summary report of risk adjustment payments June 18. The risk adjustment program is designed…
CMS is stepping up efforts to audit Medicare Advantage plans, and federal lawmakers are reintroducing legislation aimed at simplifying prior authorization in the program. Here are seven Medicare Advantage updates Becker’s has reported since May 12: