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.

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…

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 —…

  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…

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…

  The National Hemophilia Foundation (NHF) today released results from a new national online survey of registered voters that illustrates the importance and impact of patient copay assistance programs on patient affordability against the backdrop of the COVID-19 pandemic. The NHF survey, National Registered Voter Sentiment on Patient Copay Assistance Programs, found that 86 percent of…

The following post is from Julie Baak, the Practice Manager for the Arthritis Center in Saint Louis, Missouri and a fierce patient advocate. What is a Copay Accumulator? Copay accumulator programs target the most costly specialty drugs. These drugs often have copay assistance programs in place to help offset costs to patients. A copay assistance program is where…

Joshua Cohen forbes.com In January, the two largest pharmacy benefit managers (PBMs) – Express Scripts and CVS Caremark – increased the numbers of drugs on their 2020 exclusion lists. These lists include drugs that a PBM doesn’t recommend covering. PBMs’ clients – the plan sponsors – can choose not to adopt a formulary with exclusions,…

Michelle Andrews khn.org Patients who get financial help from drug companies to cover their copayments for prescription drugs could owe a bigger chunk of their costs under a proposed federal rule. The annual rule, which sets a wide range of standards regarding benefits and payments for most health plans for next year, would allow employers…