Insurance & Payors
Expert articles and analysis related to insurance & payors.
AI Summary — Last 24 Hours
In the past week, tensions regarding care accessibility have intensified, particularly with rising concerns over prior authorization processes that may disrupt patient care, as seen in a Massachusetts case where approvals delayed necessary prescriptions. Concurrently, the Trump administration's health leadership, including HHS Secretary Robert F. Kennedy Jr. and CMS, has faced mounting pressure to address the financial strain on older adults due to the expiration of enhanced ACA premium tax credits, which disproportionately affects those aged 50 to 64. Notably, these issues are compounded by the rising costs associated with hospital care in the ACA market, as reported by Aetna, which has prompted discussions around the effectiveness and pricing strategies of commercial payers, impacting overall care delivery models in value-based care systems.
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Health care prices are on the rise, and patients are flummoxed that even insurance companies aren’t doing more to control costs.
Real world experience with insurers pushing back on copay cards
As reported by Kaiser Health News: The value of drugmakers’ copay cards has become more unpredictable as insurers try to restrict their use. Many insurance plans, for instance, do not count the money ...
Hasta los pacientes se sorprenden por los precios que sus aseguradoras están dispuestas a pagar, un costo que al final pagamos todos
La inflación médica ha superado de manera constante la inflación general durante años, y las facturas de muchos procedimientos breves y de rutina llegan a decenas de miles de dólares.
Analyzing Changes in Medicare Part D Enrollment for 2026
The Medicare Part D prescription drug benefit is provided by private plans, either Medicare Advantage plans that offer drug coverage (MA-PDs) or, for those in traditional Medicare, stand-alone prescri...