Lessons Learned From Medicaid Unwinding as States Tackle Eligibility Checks
November 7th 2024Medicaid and CHIP enrollment surged from 71 million in February 2020 to 94 million by April 2023. However, with the pandemic emergency ending in May 2023, states resumed eligibility reviews, initiating a process termed “unwinding.”
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HSSP Pharmacists Demonstrate Substantial Cost Avoidance in Specialty Medication Use
October 28th 2024Cost avoidance varied by clinical setting, with the largest savings occurring in hematology clinics ($73,773), followed by rheumatology ($45,330) and pediatric gastrointestinal/irritable bowel syndrome ($16,519).
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Medicaid Budget Survey Highlights Postpandemic Challenges and Priorities
October 24th 2024The Medicaid budget survey for fiscal years 2024 and 2025 revealed state predictions are expecting a decline in Medicaid enrollment and an increase in spending next year due to the end of pandemic-era policies and federal funding.
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Breast Cancer Outcomes Improved in States With Medicaid Expansion
October 24th 2024Medicaid expansion is associated with improved care and increased survival rates for patients with certain breast cancers, but future studies should focus on whether Medicaid expansion mitigates the disparities between Black and non-White patients.
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Among near-poor Black and Hispanic individuals, Medicare Advantage was associated with increased vision care and some, although not uniform, reductions in access disparities vs traditional Medicare.
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Cost Savings From an mHealth Tool for Improving Medication Adherence
October 21st 2024The Wellth smartphone app significantly increased medication adherence and lowered unnecessary health care utilization and costs over 9 months among Medicaid beneficiaries who were self-managing chronic conditions.
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Breaking Down Co-Pay Accumulators, Maximizers and the Impact on Patients
October 18th 2024Co-pay accumulators and maximizers are 2 programs that insurers have started implementing to help them redirect financial assistance from the patient, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.
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Racial and Ethnic Disparities in Prior Authorizations for Patients With Cancer
The prior authorization process for patients with cancer demonstrates fewer days until submission and lower denial rates for Asian patients relative to White patients.
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Managing Germline Mutations in Hereditary Breast Cancer Risk
October 7th 2024Hereditary breast cancers are caused by germline mutations, which are genetic mutations inherited at conception and so called because they originate in germ cells, those that develop into reproductive cells and become eggs in female individuals and sperm in male individuals.
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Lower Drug Costs on the Horizon for Medicare Beneficiaries
September 30th 2024Average Medicare drug premiums for older Americans will drop next year for those enrolled in traditional Medicare plans or who have coverage through Medicare Advantage, with opinions divided along party lines on the economic implications.
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At-Home Cholesterol Screening Accessible Through New Program
September 30th 2024The innovative program from the Family Heart Foundation includes being able to order a free test kit for an at-home blood lipid panel and track your results online, as well as the ability to discuss the findings with care navigators and health care providers.
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State Policy Opportunities to Control Health Care Prices: A CPR Report
September 25th 2024Catalyst for Payment Reform (CPR) explores stakeholder perspectives in Florida, Michigan, and Nevada, revealing both the challenges and opportunities states face in reforming health care pricing structures.
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House Unanimously Passes Seniors’ Access to Critical Medications Act
September 25th 2024The House of Representatives unanimously passed the bipartisan Seniors’ Access to Critical Medications Act (HR 5526), which would reverse CMS restrictions on mail delivery of cancer medications to Medicare beneficiaries.
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Medicare High-Value Drug List Model Could Lower Out-of-Pocket Costs for 4 in 10 Beneficiaries
September 23rd 2024The proposed Medicare High-Value Drug List Model, also known as the Medicare $2 Drug List, could have modestly reduced out-of-pocket costs for 38% of beneficiaries if implemented in 2021.
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CMMI's Latest Payment Models Address Health Disparities, but Challenges Remain
September 22nd 2024"As CMMI continues to test new equity adjustments, it is important that changes be grounded in scientific principles with extensive testing and validation to ensure the tightest linkage to social needs and health outcomes for underserved communities across the entire US," authors wrote.
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The authors examine how insurer and patient out-of-pocket payments for advanced prostate cancer differ by drug and health plan type and describe the relationship between these payments and utilization.
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