News

The average annual healthcare spending for people with employer-sponsored insurance spending increased to $6,467 in 2021 from $5,630 in 2020. Per person healthcare spending increased 15% in 2021, following a 4% decrease in 2020.

The American Hospital Association said the health insurers' report on drug prices, which highlights the higher prices charged by hospitals, is “a blatant attempt to deflect from the obvious — insurance companies continue to raise premiums for their enrollees and employer clients while pocketing billions in profit.”

Biden's bid for re-election, AHIP takes on Pharma and the digital health's equity problems

In 2019 there were roughly 183,000 deaths associated with poverty in the U.S. among people 15 years and older. This is a significant result as the data is from the year prior to the COVID-19 pandemic when death rates skyrocketed.

HHS released the data earlier this week, which makes it the first time anyone can review the information on the ownership of more than 6,000 hospices and 11,000 home health agencies.

Medicare Advantage plans have been associated with increased screening rates. But managed care tactics and narrow networks may be a disadvantage for people needing care.

The expansion offers increased reimbursement opportunities and additional care services to rural independent pharmacies. In addition, it creates an Independent Pharmacy Advisory Committee to expand the role of rural, suburban and urban pharmacies in the healthcare system.

In this final part of a two-part video series, Clay Wilemon, CEO of 4L Data Intelligence, shared how much in cost that fraud, waste and abuse has affected healthcare due to issues like overpayment; and how leveraging your artificial intelligence can help solve fraudulent issues. Clay added how much the industry can save using these solutions.

Omisirge is a stem cell therapy that helps the body recover more quickly from cancer treatments that kill normal blood cells along with blood cancer cells, thus lowering the risk of infection.

Aetna, Signify Health and now Oak Street Health. Some see advantages to CVS acquiring a primary care provider — for U.S. healthcare as well as CVS. Others see risks of even more consolidation in the healthcare sector and perhaps a financial hit to CVS because of Oak Street’s net losses.

Social isolation loneliness is increasing and not just because of the COVID-19 pandemic. Research shows it can have devastating health consequences.

For-profit companies now dominate hospice care in the U.S., and private equity firms are moving in. Some say the trend reflects the underlying economics and need for scale.

Through Express Scripts’ new Copay Assurance plan, consumers will have lower out-of-pocket costs because of caps on prescription drugs: $5 for generics, $25 for preferred brand drugs, and $45 for preferred specialty brand drugs.

In this month’s episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx’s former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of creating whole-patient care. Throughout the conversation, Calabrese also touched on the market’s hot topic of insulin prices and behavioral health services within the OptumRx community, among other topics.

Tirzepatide was associated with a greater reduction in hemoglobin A1c and body weight versus semaglutide. Though, with a current list price of $1,023 for a one-month supply of tirzepatide (Mounjaro; Lilly), is it worth it?

This case and a case in Washington state are likely to be appealed to the Supreme Court.

Former CEO Corey McCann, M.D., Ph.D., pointed a finger at payers.

Briana Contreras, an editor with Managed Healthcare Executive, had a chat with Clay Wilemon, CEO of 4L Data Intelligence, in this month’s episode of Tuning In to the C-Suite. The discussion was on the subject of fraud, waste, and abuse within the healthcare industry and how much of it stems from issues like overpayment. Clay addressed how the adoption of artificial intelligence can help combat fraud, waste and abuse and shared how much the industry can save by using AI.

The combination of Padcev with Merck’s Keytruda has a potentially large market: approximately 8,000 to 9,000 U.S. patients would be eligible for this combination in the U.S.

Over 600 pregnant women and their newborns were analyzed to test the long-time assumption that has resulted in inconsistent data collected in past studies. For more clear results, researchers collected and evaluated pre-delivery maternal vaginal swabs and infant stool samples at 10-days and 3-months of life.

A study funded by Genentech showed that the assistance programs substantially reduce prescription abandonment regardless of race or income level.

The ruling states insurers and employers who run plans for employees will have a choice over whether and how to cover certain routine screenings, exams and tests.

Expenditures break down from managed care, out of pocket, investments and others. In 2022, the dominant share was held by managed care segment.

The new feature automatically applies manufacturer-sponsored coupons directly to an eligible patient’s order. So far, just a few pharma companies have made their coupons available through Amazon.

A bipartisan Senate bill, Affordable Insulin Now Act of 2023, would require plans to cover insulin for no more than $35 per month.

Health spending and medical care prices typically outpace growth over the overall economy, but as of mid-2022, inflation rates of the economy have reached a four-decade high.

Members of the Senate Finance Committee want to modernize the rules around PBM business practices to lower out-of-pocket costs and increase competition.

Amongst a few recommendations, Commonweath is encouraging how and how much we as payers, providers and consumers pay for primary care.