Policy

Arizona is well suited to benefit from its 1115 demonstration waiver requested from CMS because it already has a robust justice-involved reentry initiative called the Residential Substance Abuse Treatment (RSAT) Program, which is emerging as an archetype of successful reentry programs that can serve as a template for other states to emulate.

After years of efforts to reduce low-value care, panelists at the 2024 Value-Based Insurance Design Summit proposed a new strategy: drawing a line in the sand that payers will not be on the hook for these services.

During a session of the 2024 V-BID Summit, panelists Stacie Dusetzina, PhD, and Inma Hernandez, PharmD, PhD, discussed how access to essential medications is curtailed not just by the longstanding complexities of insurance design but also by emerging threats such as supply chain weaknesses and cyberattacks.

An appeals court rules against the Pharmaceutical Research and Manufacturers of America in a 340B contract pharmacy dispute; for-profit investors’ acquisition of nursing homes has raised concerns about the quality of care provided in these facilities; President Joe Biden’s proposed budget for 2025 includes changes that would do away with the current system of biosimilar interchangeability.

The author calls on Congress to address reimbursement shortfalls that are contributing to a growing physician shortage, with rural areas the hardest hit.

Most private health insurers have yet to publish criteria for when they will cover postpartum depression drug, zuranolone; state lawmakers are increasingly opposing health care mergers that they believe do not serve the public interest; Medicaid extensions made in 2021 led to a 40% decline in postpartum lack of insurance.

The Affordable Care Act (ACA) Medicaid expansions increased health care coverage for American Indian/Alaska Native (AI/AN) women of childbearing age but had limited effects on prenatal care, birth outcomes, and health care supply.

In his State of the Union Address, the president called for expanding the number of drugs subject to Medicare price negotiations and extending a $2000 out-of-pocket cap beyond seniors.

Through accountable care organizations, physicians are leveraging data and partnerships to create an efficient, quality-oriented system focused on improving patient outcomes and addressing health disparities.

President Biden will preview his plan to more than double the size of Medicare’s new drug price negotiation program in the upcoming State of the Union address; Mexicans and Central Americans were most affected by the pandemic in terms of all-cause mortality; two Alabama fertility clinics said they expect to resume in vitro fertilization (IVF) services after a bill was passed to protect doctors.

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

Getting weight loss drugs into the hands of those who need them could be a matter of changing pricing models to give more patients access to the medication they need.

When compared with patients on traditional Medicare, patients on Medicare Advantage had less intensive home health care, even if they had similar needs.

A new federal rule will provide higher Medicare payments for homeless patients, which may encourage hospitals to identify these patients and help them with their needs.

Demands for government action grow amid mounting pressures on health care; Opill offers convenient access to contraception without a prescription; the White House announces progress as drugmakers submit counteroffers for Medicare’s drug price negotiation program.

Appeals court to review ruling wiping out some cost-free preventative services; a new legislation aims to boost reimbursement rates for medical providers; changes to coverage may limit elderly home care access

A collaborative service model between a managed care organization and an affordable housing provider reduced acute care use and costs.

WHO warns of global obesity epidemic challenges; doctors advised to conserve a certain type of tetanus shot; a new set of rules will bar medical debt from consumer credit reports

Advocates for health insurance reform indicate the need to make system-wide, policy-level changes to improve patient outcomes, which include investing in improved access to care and lowering the burden of administrative costs.

Blockage of proposed bill that would protect in vitro fertilization (IVF) reignites debate over reproductive rights and health care access; ransomware attack leaves patients and providers stranded; people 65 years and older should get an additional booster for the COVID-19 vaccine, CDC says.

In a recent presentation featured at the Midwest Business Group on Health's Mental Health Forum, an expert shed light on the evolving landscape shaped by the Mental Health Parity and Addiction Treatment Act.

Survey highlights widespread opposition to Alabama's law restricting in vitro fertilization (IVF) access; investigation focuses on potential anticompetitive practices; Medicare weighs options for implementing a new program to deliver healthy meals to seniors with chronic conditions.

Congress is unlikely to include many major health care priorities in the next government funding package; many adults continue to see racism as a problem across aspects of US society; the Endocrine Society will review its clinical guidelines for gender-affirming care.

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.

Fabiola Molina, MD, MHS, is a practicing hospitalist and assistant professor of medicine at Yale School of Medicine and Yale New Haven Hospital. An immigrant from Mexico, her experiences straddling 2 worlds, while attempting to navigate with her family the complicated safety-net system for health care in Texas, were key influences to her ardent focus on health equity.

In this final part of our interview with James Robinson, PhD, MPH, he underscores the need for employer education about the health plans they offer, fostering managed competition among hospital systems to drive down costs, and innovation in financing drug development.

Patients with cancer express shock and anxiety over the recent ruling by the Alabama Supreme Court regarding frozen embryos; doctors are beginning to charge fees for administrative tasks; some universities are implementing accelerated nursing programs to help with the shortage.

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.

In part 3 of our interview with James Robinson, PhD, MPH, he discusses the need for reforms to commercial insurance that reflect the changes to Medicare under the Inflation Reduction Act, how the 340B drug pricing program has veered widely from its original goals, and ongoing cost sharing struggles among patients, insurers, hospitals, and drug companies.

Shauna Downs, PhD, MS, is an associate professor in the Department of Health Behavior, Society, and Policy at the Rutgers School of Public Health. A former figure skater, her research now focuses on interventions to promote healthy and sustainable food choices and exploring how our changing climate, food systems, diet, and nutrition are inextricably linked.