States Get in on the Prior Authorization Crackdown
Last month, my colleague Lauren Sausser told you about the Biden administration’s crackdown on insurance plans’ prior authorization policies, with new rules for certain health plans participating in federal programs such as Medicare Advantage or the Affordable Care Act marketplace. States are getting in on the action, too. Prior authorization, sometimes called pre-certification, requires patients […]
Utilization management for biosimilars – Healthcare Economist
When we think of utilization management (e.g., prior authorizations, step edits), we often think payers only use these for higher cost branded products including biologics. Generic drugs should have low cost sharing and limited utilization management. One question, however, is whether payers’ utilization management practices for biosimilars mirror those of biologic products, or small-molecule generics, […]
5 Tips for Maximizing Health Benefits
Discover effective strategies to enhance employee engagement and maximize the potential of your health benefits program.
Patients See First Savings From Biden’s Drug Price Push, as Pharma Lines Up Its Lawyers
Last year alone, David Mitchell paid $16,525 for 12 little bottles of Pomalyst, one of the pricey medications that treat his multiple myeloma, a blood cancer he was diagnosed with in 2010. The drugs have kept his cancer at bay. But their rapidly increasing costs so infuriated Mitchell that he was inspired to create an […]
Dental Coverage under the ACA: Marketplace Rule Would Give States the Opportunity to Expand Coverage
By Zeynep Çelik, JoAnn Volk, Lindsay Cox, and Kevin Lucia Dental care is an important element of comprehensive health care. Oral health impacts job opportunities and children’s success in school, and dental complications, if left untreated, can lead to negative health outcomes and even death. Inability to pay is a major obstacle to dental care, […]
Why Does the United States Pay, by Far, the Highest Prices in the World for Prescription Drugs? – Healthcare Economist
That is the topic of a U.S. Senate hearing last week. One person testifying was an economist, USC Professor Darius Lakdawalla. While his full testimony is here, his key points of contention are worth reading. These include: The challenge for public policy is to sustain the pace of medical innovation […]
The Pros and Cons of Group Health Plans
Group health insurance has been around for decades. Is it the right choice for your organization and your employees? Explore the advantages and disadvantages of group health plans and discover a better alternative for employee healthcare.