Insurance

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Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients

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When Paula Chestnut needed hip replacement surgery last year, a pre-operative X-ray found irregularities in her chest. As a smoker for 40 years, Chestnut was at high risk for lung cancer. A specialist in Los Angeles recommended the 67-year-old undergo an MRI, a high-resolution image that could help spot the disease. But her MRI appointment … Read more

Planes de salud de Medicaid intentan proteger a sus miembros… y a sus ganancias

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Las protecciones federales por la pandemia de covid-19, que desde 2020 prohibieron a los estados eliminar a beneficiarios de Medicaid, incluso si ya no calificaban, lograron bajar el número de personas sin seguro de salud a un mínimo histórico. También generaron ganancias inesperadas para los planes de salud, que los estados pagan para supervisar la … Read more

Why Does Insulin Cost So Much? Big Pharma Isn’t the Only Player Driving Prices

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Eli Lilly & Co.’s announcement that it is slashing prices for its major insulin products could make life easier for some diabetes patients while easing pressure on Big Pharma. It also casts light on the profiteering methods of the drug industry’s price mediators — the pharmacy benefit managers, or PBMs — at a time when … Read more

Medicaid Health Plans Try to Protect Members — And Profits — During Unwinding

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The federal covid-19 pandemic protections that have largely prohibited states from dropping anyone from Medicaid since 2020 helped millions of low-income Americans retain health insurance coverage — even if they no longer qualified — and brought the U.S. uninsured rate to a record low. It also led to a windfall for the health plans that … Read more