From Inside Health Insurance Exchanges - With the King v. Burwell case settled, President Obama is putting pressure on states to expand their Medicaid programs. And there are both rewards and risks for some carriers if they do. Twenty-nine states have expanded Medicaid as called for by the Affordable Care Act (ACA). While state leaders might have a strong interest in covering a larger percentage of their poor, political, fiscal and ideological differences often limit what can be done. “States aren’t really debating whether to do a coverage expansion. Read more
From Health Plan Week - Scrutiny on rising drug prices is driving increased interest in value-based pricing models, as health insurers look to cut costs and drug manufacturers seek an edge on their competitors in an increasingly crowded pharmaceutical market. Read more
From Inside Health Insurance Exchanges - If the Supreme Court had ruled in favor of the plaintiff in King v. Burwell (AIS Alert, 6/25/15), there was optimism among some employers that certain provisions of the Affordable Care Act (ACA) would crumble. With the law now more firmly in place, more employers are looking to private exchanges as a possible strategy to help sidestep the so-called Cadillac tax, which is slated to go into effect in 2018. Most… Read more
From Medicare Advantage News - It is not hard to see in the revised Medicare Marketing Guidelines that CMS released July 2 what issues are at the top of the agency’s mind in terms of needing marketing-related regulatory changes. A good chunk of the revisions relate to (1) the accuracy and dissemination of directories of network providers and pharmacies, (2) the need for clear disclaimers in language about member benefits and costs and (3) the… Read more
From Specialty Pharmacy News - If 10% of Californians who have hepatitis C are treated with newer, more effective yet costly specialty drugs, projected costs over the next 12 months would be $4.77 billion, with $2.05 billion of that spent on the state-funded population. That’s one of the findings of a study conducted by The Taylor Feldman Group for the California Association of Health Plans that was released last month. Read more
From Report on Medicare Compliance - Hospitals and physicians in a funk over audits and the reimbursement squeeze may get a boost from telemedicine, which is covered by more payers and taking new forms all the time. Medicare fee-for-service doesn’t reimburse telehealth services outside rural and medically underserved areas, but coverage there was expanded this year. Read more
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