Policy

New rules aim to curb insurance brokers and protect consumers; data highlights surge in post-pandemic hospital-onset infections; President Biden’s decision to step down highlights Harris’ stance on health care reform and equity.

Doug Fulling, MA, and Andrew Cournoyer, MBA, discuss how patients could benefit from payers learning more about a new drug by joining clinical trials earlier.

Rising COVID-19 cases are attributed to travel, heatwaves, and new variants; an analysis highlights challenges in states not expanding Medicaid; the FDA notes health risks despite marketing authorization for popular e-cigarettes.

This study examined employers’ understanding of rebate guarantees, dependency upon rebate dollars, and the role that pharmaceutical rebates or employer benefits consultants play in their pharmacy benefits manager selection.

Misleading ads are under scrutiny for their role in signing up consumers for Affordable Care Act (ACA) coverage without their permission; Sen Elizabeth Warren (D, Massachusetts) said there are enough votes in the Senate to suspend the filibuster to codify Roe v Wade in 2025 with a Democratic majority; women with endometriosis have about a fourfold risk of developing ovarian cancer.

The Commonwealth Fund scorecard ranks Mississippi, Texas, Nevada, and Oklahoma among the poorest-performing states overall for women’s health care access, quality, and outcomes, while Massachusetts, Vermont, and Rhode Island rank at the top.

Almost half of all Americans struggle to afford quality health care and prescription medications; the cyberattack on UnitedHealth Group's Change Healthcare unit will cost the company between $2.3 billion and $2.45 billion in 2024; CMS releases the final part 2 guidance for plan outreach and education for the Medicare Prescription Payment Plan.

Learn more about the 2025 Physician Fee Schedule, new health equity initiatives, improving maternal health, and pharmaceutical innovations at the Center on Health Equity & Access.

Pfizer announced plans for a once-a-day weight-loss pill; toxic metals have been found in over a dozen popular tampon brands across the US; CMS proposed a new rules impacting telehealth in the Medicare physician fee schedule (PFS) for 2025.

The 2025 Physician Fee Schedule includes a conversion factor reduction, expanded behavioral health services, extended telehealth waivers, new Quality Payment Program pathways, and measures to address suspect billing, alongside a Biden administration initiative introducing federal maternal health standards for hospitals.

The US Senate Committee on Health, Education, and Labor Pensions discussed actionable solutions to address the medical debt crisis impacting millions of individuals.

Today, the Siftwell 2024 Medicaid-Eligible Health Equity Index report highlighted ongoing challenges and barriers that underscore the need for systemic changes to improve health care access and outcomes for vulnerable groups.

The Federal Trade Commission (FTC) is preparing a lawsuit against the 3 largest drug middlemen over their use of rebates for insulin and other drugs; Sen Bernie Sanders (I, Vermont) feels confident that Novo Nordisk will cut Ozempic and Wegovy costs after hearing; CMS proposed a payment rule that would increase Medicare reimbursement for hospital outpatient departments by 2.6% next year.

More patients achieve significant weight loss with tirzepatide; new data show significant increases in sexually transmitted disease (STD) diagnoses; many individuals in cardiology deserts are left at higher risk of dying from heart disease.

In 2024, physicians face significant financial challenges due to declining Medicare reimbursement rates and high student loan interest rates, which will impact health care delivery and access.

Crystal S. Denlinger, MD, FACP, CEO of the National Comprehensive Cancer Network, breaks down the causes of the ongoing cancer drug shortage, as well as its impact on clinical trials.

Medicare tightens rules after alleged $3 billion fraud scheme; new Alzheimer disease diagnostic criteria are causing controversy; loss of Medicaid is tied to struggles affording health care.

Underserved communities, already facing higher asthma prevalence due to social determinants of health, are disproportionately affected by the impact climate change is having on asthma exacerbations. Potential solutions include education for patients and health care providers, climate litigation to establish environmental rights, and policy changes to curb climate change.

Liz Kwo, MD, MBA, MPH, chief commercial officer, Everly Health, and faculty lecturer, Harvard Medical School, shares important tips on how artificial intelligence (AI) can best be implemented into value-based care.

Insurers continue to raise consumer costs despite covering fewer drugs and having more drug coverage restrictions; the Biden Administration is investing hundreds of millions of dollars to train geriatricians; the Federal Trade Commission has opened an investigation into Teva Pharmaceuticals after the company refused to take down patents for its asthma and chronic obstructive pulmonary disease inhalers.

Experts urge enhanced monitoring as avian influenza spreads beyond birds; emergency abortion access still in legal limbo; leaders call for federal probe into potential misuse of health insurance subsidies.

Asthma is worsening under the effects of climate change, such as air pollution and pollen production, especially for underserved populations.

The use of Plan B fell by 60% in states that implemented near-total abortion bans after Roe v. Wade was overturned; the Biden administration will impose inflation penalties on 64 prescription drugs in the third quarter of 2024; the FDA recently released draft guidance to ensure that drug companies and medical device makers enroll more women and people of color in clinical trials.

On this episode of Managed Care Cast, we're talking with the author of a study published in the June 2024 issue of The American Journal of Managed Care® about how annual high-deductible insurance plans increase maternity care costs when pregnancies cross 2 calendar years.

In this fifth, and final, special bonus episode of our Pride Month series, we speak with Lauren Albrecht, director of advocacy and organizing, and Layla Orlando, director of health equity and wellness, at Garden State Equality, the largest lesbian, gay, bisexual, transgender, queer, plus advocacy organization in New Jersey.