Many Ohioans lack access to prescription medications because insurers and pharmacy benefit managers are increasingly making it more difficult for patients to afford them. High-deductible health plans, copayments, coinsurance, copay accumulators, restrictive formularies, etc. are all tactics used to simply push more of the cost-share onto the patient.

For one drug at least, biggest insurers force Medicare patients to buy the most expensive

For one drug at least, biggest insurers force Medicare patients to buy the most expensive
December 7, 2021

In theory, the point of managed care is to save money by negotiating with providers for lower prices. So it would seem that the biggest managed-care providers would use their clout to negotiate the lowest prices from doctors and hospitals and for medicine…

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Congressional group takes up PBMs, strikes a partisan tone

Congressional group takes up PBMs, strikes a partisan tone
November 26, 2021

Members of Congress last week took up an issue potentially of great importance: What to do about powerful health conglomerates who play an increasingly powerful role in the drug-supply chain…

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CVS sometimes forces people to use its pharmacies. Now the Supreme Court will weigh in

CVS sometimes forces people to use its pharmacies. Now the Supreme Court will weigh in
November 5, 2021

At issue is whether “patient steering” can be discriminatory

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Rules block patients from counting thousands in drug discounts toward health insurance deductible

Rules block patients from counting thousands in drug discounts toward health insurance deductible
June 21, 2021

Rules block patients from counting thousands in drug discounts toward health insurance deductible

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Centene agrees to settle Medicaid claims with Ohio, Mississippi for $143 million

Centene agrees to settle Medicaid claims with Ohio, Mississippi for $143 million
June 21, 2021

In what could be a harbinger of more settlements, Medicaid managed-care contractor Centene on Monday settled potential fraud claims by Ohio and Mississippi for $88.3 million and $55 million, respectively.

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New Analysis: ICER Framework Ignores Patient Preferences, Innovation & Societal Benefits in Evaluating Cost-Effectiveness of New Cancer Treatments

New Analysis: ICER Framework Ignores Patient Preferences, Innovation & Societal Benefits in Evaluating Cost-Effectiveness of New Cancer Treatments
April 7, 2021

Policymakers Should Ban the Use of the Quality Adjusted Life Years (QALY) Methodology in Evaluating New Cancer Therapies & Prohibit ICER from Advising Government Agencies Media inquiries: Contact Micaela Dawson, mdawson @pioneerinstitute .org Boston – Pioneer Institute today released a new analysis, The QALY and Cancer Treatments: An Ill-Advised Match, that examines the alarming methodological and contextual shortcomings of…

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Trump, Biden Medicare Moves Need Fixing

Trump, Biden Medicare Moves Need Fixing
March 4, 2021

By PATRICK J. KENNEDY | March 4, 2021 at 5:16 a.m. On Donald Trump’s last full day in office, his administration announced a policy change that would make it easier for insurers to deny medicine to vulnerable Medicare beneficiaries. Those most affected will include people with mental health disorders, a group that already faces major roadblocks —…

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Manchester, West introduce Patient Protection legislation

Manchester, West introduce Patient Protection legislation
March 3, 2021

  COLUMBUS – State Representatives Susan Manchester (R-Waynesfield) and Thomas West (D-Canton) recently introduced House Bill 135, which would cut out-of-pocket prescription drug costs for patients. The legislation is supported by a large coalition of patient advocate and healthcare provider organizations. Some patients with chronic, complex conditions such as multiple sclerosis and hemophilia rely on…

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How a quiet co-pay rule change could mean massive drug cost increases

How a quiet co-pay rule change could mean massive drug cost increases
October 22, 2020

BY TERRY WILCOX AND STACEY WORTHY The COVID-19 pandemic has hit those with chronic diseases especially hard. According to its most recent weekly summary, the Centers for Disease Control and Prevention estimates that 91% of patients hospitalized with the disease have at least one underlying medical condition. Patients with chronic diseases face an additional burden due to a…

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