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What If Costco Designed the Prescription Drugs Sales Model?

Health Populi

Fast-forward through the 1990s and the advent of PBMs — pharmacy benefit management companies — the intermediaries managing drug benefits for health insurance plans. Today, the three largest PBMs, processing about 4 in 5 retail prescription claims, are embedded in large health insurance companies.

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HHS OIG Report On Prior Authorizations Under Medicare Advantage

Healthcare Law Blog

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report.

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Monthly Round-Up of What to Read on Pharma Law and Policy

Bill of Health

from 2018-2019. Therapeutic Value Assessments of Novel Medicines in the US and Europe, 2018-2019. Hospital-Administered Cancer Therapy Prices for Patients With Private Health Insurance. The post Monthly Round-Up of What to Read on Pharma Law and Policy appeared first on Bill of Health. JAMA Oncol. JAMA Netw Open.

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2018 Medicare Fee-For-Service improper payment rate is lowest since 2010

CMS.gov

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Fri, 11/16/2018 - 18:46. Administrator, Centers for Medicare & Medicaid Services. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 percent in 2018. percent in 2018. percent in 2018.

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From Evolution to Innovation, from Health Care to Health: How Health Plans With Collaborators Are Re-Defining the Industry

Jane Sarashon

Furthermore, health plan members now see themselves as medical bill payers, seeking value and consumer-level services for their health insurance premium investment. According to the online Merriam-Webster dictionary , the first use of the phrase “health insurance” occurred in 1901. Retail health-meets-Medicare.

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Health Care Costs Concern Americans Approaching Retirement – Especially Women and Sicker People

Health Populi

Even with the prospect of enrolling in Medicare sooner in a year or two or three, Americans approaching retirement are growing concerned about health care costs, according to a study in JAMA Network Open. One-half said they weren’t confident in their ability to afford health insurance in or near retirement.

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Use of Preventive Health Services Declined Among Commercially Insured People – With Big Differences in Telehealth for Non-White People, Castlight Finds

Health Populi

Declines in preventive care services like cancer screenings and blood glucose testing concern employers, whose continued to cover health insurance for employees during the pandemic. But Castlight expects a flat-line in PMPM spending for 2022, leveling out at $4,232 per member/per month for commercially-insured employees.

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