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Attorney General seeks financial info from Medicaid contractors  Investigation might focus on possible law violations

Attorney General seeks financial info from Medicaid contractors Investigation might focus on possible law violations
March 11, 2022

In the past month, Ohio Attorney General Dave Yost has sought financial information from the state’s five managed-care contractors, documents received in response to an open-records request show. The AG won’t discuss ongoing investigations, but he might be looking into whether some practices by subcontractors who manage pharmacy benefits violate state law or federal regulations.

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Bill to ban limits on prescription drug co-pay help remains stalled in Ohio House

Bill to ban limits on prescription drug co-pay help remains stalled in Ohio House
March 10, 2022

Sara Sharpe, 34, has a pretty basic wish: She doesn’t want to suffer a potentially fatal allergic reaction “because of insurance company paperwork” foul-ups. She is one of millions nationwide caught up in a money-saving move by health insurance companies with the unwieldy name of “co-pay accumulators.” People in this diverse group, many suffering from rare diseases, are casualties of…

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Report: Medicare drug reforms would save seniors billions

Report: Medicare drug reforms would save seniors billions
March 10, 2022

There’s been a lot of talk about ways to reduce the cost of prescription drugs. In last week’s State of the Union Address, for example, President Joe Biden proposed allowing Medicare to negotiate directly with drugmakers in an attempt to bring prices down.

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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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