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From Drug Benefit News - Although the ongoing repeal-and-replace debate over the Affordable Care Act has taken up most of the attention in Washington, D.C., drug pricing and access also are on the radar in Congress. DBN rounds up six of the bills under consideration and how they are being received. Read more

From Health Plan Week - Anthem, Inc. says it is trying to save money while getting its patients more engaged in their health care by implementing a new emergency room policy that some critics say is too harsh. The policy, implemented in several states, denies coverage of ER care for certain conditions that Anthem says would be better treated at a physician’s office or urgent care center. Read more

From Health Plan Week - It’s been a year since a batch of Consumer Operated and Oriented Plans (CO-OPs), nonprofit plans created by the Affordable Care Act (ACA), failed in Illinois, Oregon and Connecticut. More recently, Evergreen Health in Maryland dropped out of the CO-OP program, got state approval to convert to for-profit status, and intends to participate in the state exchange’s individual and small-business markets for 2018 *(HPW 6/26/17, p. Read more

From Medicare Advantage News - As Medicare Advantage insurers show increasing interest in moving physicians down the path toward value-based care, Irvine, Calif.-based ConcertoHealth is taking a two-pronged approach to supporting the network needs of its health plan partners across a variety of settings. Originally a provider-led MA plan called Fidelis Secure Care, the company under new ownership was renamed and divested its MA assets in 2014 to focus on the provider side. Read more

From Specialty Pharmacy News - Although UnitedHealthcare already requires prior authorization for genetic and molecular testing, the health insurer will roll out an online program nationally this fall for tests performed in an outpatient setting. The offering, according to the company, should help streamline the process and give insight into costs for multiple tests. Providers requesting lab testing will need to complete the prior-authorization process themselves, while participating labs “will be responsible for determining if an… Read more

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