Insurance

Out-of-pocket costs of diabetes medications other than insulin can be quite high for individuals with employer-sponsored health insurance.

Payer costs for COVID-19 ranged from a mean of $505 for asymptomatic cases to $126,094 for severe cases with post–COVID-19 condition.

Among a cohort of insured patients with cancer, the median total monthly cost of oral lenvatinib was $17,253, and 75% of patients paid $100 or less out of pocket per month for the drug.

The Democratic Women’s Caucus is urging insurers to comply with the Affordable Care Act (ACA) contraception requirement to cover birth control without cost sharing.

The House Democratic Women’s Caucus wrote a letter urging insurers to comply with both contraceptive coverage requirements and recent Biden administration guidance; several pharmacy chains are experiencing disruptions following a hack at Change Healthcare, UnitedHealth’s technology unit; the FDA said it is not planning to take a tougher stance against clinical trial reporting requirement noncompliance.

The amount of in-network care claims jumped significantly after surprise billing protections took effect; experts say the US is in the midst of the “fourth wave” of the opioid epidemic; the prevalence of long COVID symptoms 30 and 90 days post infection was 43% to 58% lower among adults who were fully vaccinated before infection.

Carrie Kozlowski, OT, MBA, chief operating officer and cofounder of Upfront Healthcare, explains how the company emphasizes personalized engagement to overcome technological, cultural, and social barriers while Medicaid disenrollment rates are increasing.

Part of the recent Medicare reimbursement cuts could be addressed in a spending package next month; Medicaid/Medicare dual eligibles are expected to generate big profits for health insurers; FDA sent warning letters to online vendors selling unapproved and misbranded versions of semaglutide and tirzepatide.

"I'll say what I don't think the issue is—it's not technology. We can solve this problem with technology," Carrie Kozlowski, OT, MBA, explains in the interview.

On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.

The federal State Health Insurance Assistance Program (SHIP) provides counseling and education on Medicare coverage options. This article highlights potential inequities in in-person SHIP service access.

Over the past 20 years, Medicare physician pay has plummeted by 26% when adjusted for inflation, while hospital reimbursement has surged by 70%, prompting over 100,000 doctors to abandon independent practice for hospital or corporate employment since 2019.

Overcoming insurance hurdles for critical medications; rising heat and wildfires reverse decades of clean air progress; conflicts between parents and schools arise as teens seek mental health support

This study leverages newly available hospital pricing data to explore hospital-insurer contracts from a large hospital chain.

Catch up on this week's news at the Center on Health Equity and Access.

At an Institute for Value-Based Medicine® event held in Phoenix, Arizona, experts from Banner Health and Aetna discussed how health inequities and social determinants of health can affect primary care in patients with any type of insurance.

A provision in the Inflation Reduction Act will implement a $2000 out-of-pocket cap on Medicare beneficiaries’ prescription drug spending, which could save money for more than 1 million enrollees when it takes effect next year.

House Republicans voted to ban quality-adjusted life years (QALYs) from being used as a drug pricing metric in federal health programs; insurance executives disapproved of newly proposed 2025 Medicare Advantage (MA) rates; patients with long COVID enrolled in an online exercise program said their health improved more than people who received standard care.

Medicare coverage did not necessarily lead to increased diagnosis of chronic conditions.

A total of 16,430,000 Medicaid enrollees have been disenrolled across all 50 states and the District of Columbia, as of February 1, 2024.

This study provides insight on the experiences of patients of a national health plan with 2 structural determinants of health—health care discrimination and health literacy—and how those interact with social determinants of health and patient demographics.

The article emphasizes the significance of accreditations in addressing health disparities and promoting health equity, highlighting programs for achieving accreditation and advocating for the integration of social determinants of health (SDOH) and health equity practices within pharmacy and health care.

Payers, health systems, and health professionals will experience expanded accountability for performance in closing health disparity gaps in 2024.

Drug prices in the US increased 4.4% annually and median out-of-pocket (OOP) costs increased 9.6% annually from 2009 to 2018, but there was no direct link between these amounts for individual drugs.

The Center on Health Equity and Access delivers current updates, highlights breakthroughs in research, and ongoing endeavors committed to addressing healthcare inequalities and improving universal access to exceptional health care.