How a Duty To Spend Wisely on Worker Benefits Could Loosen PBMs’ Grip on Drug Prices
As criticism of pharmacy benefit managers heats up, fear of lawsuits is driving some big employers to drop the “Big Three†PBMs — or force them to change.
Connecticut
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With Trump on the Way, Advocates Look to States To Pick Up Medical Debt Fight
Patient and consumer advocates fear a new Trump administration will scale back federal efforts to expand financial protections for patients and shield them from debt.
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Who Gets Obesity Drugs Covered by Insurance? In North Carolina, It Helps If You’re on Medicaid
GLP-1 agonist medications such as Ozempic accounted for 10% of the North Carolina state employee health plan’s prescription drug spending, so the state is no longer covering them for weight loss alone. Still, it did decide to cover them for Medicaid patients’ weight loss. A look inside the state’s coverage calculus.
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California Sets 15% Target for Primary Care Spending Over Next Decade
The state Office of Health Care Affordability has set a goal for insurers to direct 15% of their spending to primary care by 2034, part of a push to expand preventive care services. Health plans say it’s unclear how the policy will mesh with the state’s overarching goal to slow spending growth.
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California Bill Would Require State Review of Private Equity Deals in Health Care
Proposed legislation would require the state attorney general’s consent for a wide range of private equity acquisitions in health care. The hospital lobby negotiated an exemption for for-profit hospitals.
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Federal Panel Prescribes New Mental Health Strategy To Curb Maternal Deaths
The leading causes of pregnancy-related deaths in the United States — including suicides and fatalities linked to substance use disorders — stem from mental health conditions. Now a federal task force has recommended strategies to help women who are at risk during or after pregnancy.
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Nursing Homes Wield Pandemic Immunity Laws To Duck Wrongful Death Suits
More than 172,000 nursing home residents died of covid. In lawsuits, some families who lost loved ones say they were misled about safety measures or told that covid wasn’t a danger in their facilities.
By Fred Schulte -
Older Americans Say They Feel Trapped in Medicare Advantage Plans
As enrollment in private Medicare Advantage plans grows, so do concerns about how well the insurance works, including from those who say they have become trapped in the private plans as their health declines.
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States Begin Tapping Medicaid Dollars to Combat Gun Violence
The Biden administration is allowing states to use money from the insurance program for low-income and disabled residents to pay for gun violence prevention. California and six other states have approved such spending, with more expected to follow.
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States Expand Health Coverage for Immigrants as GOP Hits Biden Over Border Crossings
More than 1 million immigrants, most lacking permanent legal status, are covered by state health programs. Several states, including GOP-led Utah, will soon add or expand such coverage.
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‘They See a Cash Cow’: Corporations Could Consume $50 Billion of Opioid Settlements
As opioid settlement dollars land in government coffers, a swarm of businesses are positioning themselves to profit from the windfall. But will their potential gains come at the expense of the settlements’ intended purpose — to remediate the effects of the opioid epidemic?
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Millions in Opioid Settlement Funds Sit Untouched as Overdose Deaths Rise
Some states haven't begun using opioid settlement funds intended to help curb the opioid epidemic. Meanwhile, more than 100,000 Americans died of an overdose last year.
By Katheryn Houghton and Aneri Pattani -
Out for Blood? For Routine Lab Work, the Hospital Billed Her $2,400
Convenient as it may be, beware of getting your blood drawn at a hospital. The cost could be much higher than at an independent lab, and your insurance might not cover it all.
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States Reconsider Religious Exemptions for Vaccinations in Child Care
Providers and health care advocates warn a proposed rule change in Montana would jeopardize immunity levels in child care centers and communities. Efforts to change vaccination exemption rules are underway in other states, too.
By Matt Volz -
Start Shopping: Enrollment Begins Nov. 1 for Most Obamacare Insurance Plans
More than 16 million Americans who buy their own health insurance through state and federal marketplaces have until Jan. 15 to compare prices, change their coverage, or enroll for the first time.
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Using Opioid Settlement Cash for Police Gear Like Squad Cars and Scanners Sparks Debate
State and local governments will receive a windfall of more than $50 billion over 18 years from settlements with companies that made, sold, or distributed opioid painkillers. Using the funds for law enforcement has triggered important questions about what the money was meant for.
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Feds Try to Head Off Growing Problem of Overdoses Among Expectant Mothers
Homicides, suicides, and drug overdoses have driven rising rates of pregnancy-related death in the U.S. This fall, six states received federal funding for substance use treatment interventions to prevent at least some of those deaths.
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Rare ‘Flesh-Eating’ Bacterium Spreads North as Oceans Warm
A rise in cases of Vibrio vulnificus and its spread northward have heightened concern about the bacterium, which can cause human tissue to rot and skin to decay. The Centers for Disease Control and Prevention is trying to make more doctors aware of the dangerous pathogen.
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Feds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients
Software sifts through millions of medical records to match patients with similar diagnoses and characteristics and then predicts what kind of care an individual will need and for how long. New federal rules will ensure human experts are part of the process.
By Susan Jaffe -
Cozy Images of Plush Toys and Blankets Counter Messaging on Safe Infant Sleep
Unsafe sleep environments are among the main reasons accidental suffocation or strangulation is a hard-to-solve public health problem.