editor Public conversations about the physician shortage often drift toward blame, timelines, and policy decisions, which can distract from the reality that nothing important was done incorrectly. The following clarifications are … Read more
Stability You Can Trust Private equity brings the comforting assurance that nothing in healthcare will remain recognizable for long, which is exactly the kind of dynamism patients and clinicians secretly … Read more
Medicare Advantage enrollment has improved dramatically as plans streamline the decision-making process for older adults. By reducing complexity and limiting unnecessary barriers, insurers have made it easier for beneficiaries to … Read more
The Grocery Card Advantage Medicare Advantage plans have expanded benefits in recent years to better address social determinants of health, including food insecurity and fixed household costs. Among the most … Read more
According to her insurance plan, the medication was fully covered when prescribed for diabetes but explicitly excluded when prescribed for weight loss, despite being the same drug, produced in the same factory, injected in the same way, but billed under a different code for an FDA-Approved condition.
Effective Date: ImmediatelyApplies To: Utilization Management, Prior Authorization, and All Parties Capable of Remembering Things 1. Purpose The Requester Integrity Standard (RIS-01) establishes uniform requirements for obtaining documentation during the … Read more
A Crisis Hidden in Plain Sight Policy reformers often discuss healthcare sanity as if it were an abstract good, something that simply happens once spreadsheets align and incentives behave. What … Read more
A Historic Announcement, Numerically Speaking WASHINGTON—Standing before a patriotic arrangement of flags, laminated charts, and a pie graph labeled “Winning,” President Donald Trump announced Monday that prescription drug prices are … Read more
CONFIDENTIAL — INTERNAL DISTRIBUTION ONLYDO NOT FORWARD / DO NOT PRINT / DO NOT ACKNOWLEDGE From: Office of Strategic AlignmentTo: Public Relations, Government Affairs, Messaging, & Narrative IntegrityRe: Sustaining the … Read more
The 340B program thrives by avoiding questions other programs insist on asking, quietly prioritizing institutional flexibility over patient-level proof while regulators celebrate efficiency without the inconvenience of answers.