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
WASHINGTON—Several major insurance companies announced voluntary price reductions Friday after learning that President Trump intended to ask them “nicely” to lower costs during a meeting scheduled for later this month. … Read more
Insurers announced a new tool. They say it improves transparency, efficiency, and margins. They mostly say efficiency. It’s called the Guess-o-meter™. A proprietary system. No outside review. No explanation. The … Read more
WASHINGTON—Health insurers confirmed this week that prescription formularies are built using a disciplined, data-driven method known internally as “Who Brought the Biggest Rebate.” Executives described the process as neutral, objective, … Read more
WASHINGTON—Patients across the country are reporting significant savings on prescription medications after discovering a bold new cost-containment strategy: politely ignoring the insurance plan they pay for every month. “I ran … Read more