Tag Archives: Health Insurance and Managed Care

President Trump on Monday signed an executive order asking drugmakers to voluntarily reduce the prices of key medicines in the United States. But the order cites no obvious legal authority to mandate lower prices. The order said the administration would consider taking regulatory actions or importing drugs from other countries in the future if drugmakers do not comply. It was …

President Trump will sign an executive order on Monday aimed at lowering some drug prices in the United States by aligning them with what other wealthy countries pay, he said on Truth Social on Sunday evening. The proposal he described, which alone cannot shift federal policy, is what he calls a “most favored nation” pricing model. Mr. Trump did not …

President Trump will sign an executive order on Monday aimed at lowering some drug prices in the United States by aligning them with what other wealthy countries pay, he said on Truth Social on Sunday evening. The proposal he described, which alone cannot shift federal policy, is what he calls a “most favored nation” pricing model. Mr. Trump did not …

Tens of thousands of Americans will soon be forced by their heath insurance to switch from one popular obesity drug to another that produces less weight loss. It is the latest example of the consequences of secret deals between drugmakers and middlemen, known as pharmacy benefit managers, that are hired by employers to oversee prescription coverage for Americans. Employers pay …

Two independent medical practices in Minnesota once hoped to expand operations but have spent the past year struggling to recover from the cyberattack on a vast UnitedHealth Group payment system. Odom Health & Wellness, a sports medicine and rehabilitation outfit, and the Dillman Clinic & Lab, a family medicine practice, are among the thousands of medical offices that experienced sudden …

The Justice Department on Thursday accused three of the nation’s largest health insurers of paying hundreds of millions of dollars in illegal kickbacks over several years to insurance brokers that steered people into private Medicare plans. Federal prosecutors also accused two of the insurers of colluding with brokers to discriminate against people with disabilities, by discouraging enrollment in the private …

The Trump administration announced Friday it would delay the implementation of a Biden-era rule meant to restrict coverage of unproven and costly bandages known as skin substitutes. The policy will be delayed until 2026, allowing companies to continue setting high prices for new products, taking advantage of a loophole in Medicare rules. The companies sell those bandages at a discount …

Companies can set such high prices because of a quirk in Medicare pricing rules, industry experts said. For the first six months of a new bandage product’s life, Medicare will set the reimbursement rate at whatever price a company chooses. After that, the agency adjusts the reimbursement to reflect the actual price paid by doctors after any discounts. To circumvent …

In 2023, companies billed Medicare for hundreds of thousands of urinary catheters that doctors never ordered. The next year, doctors collected billions from the government for pricey bandages that were sometimes unneeded. Medicare waste has wide-reaching consequences. Even if patients do not pay the bills themselves, more spending by the government insurance program can increase future premiums. The New York …

If congressional Republicans go through with some of the deep Medicaid cuts they are considering, three states would be left in an especially tight bind. South Dakota, Missouri and Oklahoma have state constitutions requiring that they participate in Medicaid expansion, the part of Obamacare that expanded the health program for the poor to millions of adults. If Republicans choose to …