A rule taking effect Jan. 1 was intended to stop one set of abuses by pharmacy benefit managers, or PBMs, but some pharmacists say it’s enabling these price brokers to simply do new things unfairly.
Category: Cost and Quality
Quick Genetic Test Offers Hope for Sick, Undiagnosed Kids. But Few Insurers Offer to Pay.
A new, rapid genetic test shows promise in increasing diagnoses and improving treatment for some children with rare genetic conditions. Many insurers won’t cover it, but Florida’s Medicaid program is among those that see benefits — and, potentially, savings.
Facing Criticism, Feds Award First Maternal Health Grant to a Predominantly Black Rural Area
Mississippi has the highest rate of Black maternal mortality and morbidity in the U.S. Now, it also has a federal grant to help in rural areas. The award could signal more flexibility from federal officials.
These Appalachia Hospitals Made Big Promises to Gain a Monopoly. They’re Failing to Deliver.
Ballad Health, the only hospital system across a large swath of Tennessee and Virginia, has fallen short of quality-of-care and charity care obligations — even as it’s sued thousands of patients for unpaid bills.
Biden Administration to Ban Medical Debt From Americans’ Credit Scores
The White House said the Consumer Financial Protection Bureau will develop new regulations that would prevent unpaid medical bills from being counted on credit reports.
Your Exorbitant Medical Bill, Brought to You by the Latest Hospital Merger
After decades of unchecked mergers, health care is the land of giants, with huge medical systems monopolizing care in many cities, states, and even whole regions of the country. This decreases patient choice, impedes innovation, erodes quality of care, and raises prices. And federal regulators have been slow to act.
Sen. Sanders Says Millions of People Can’t Find a Doctor. He’s Mostly Right.
The Vermont senator sees beefing up the primary care workforce as a critical step in expanding Americans’ access to health care.
Be Aware: Someone Could Steal Your Medical Records and Bill You for Their Care
Consumers should know that this type of fraud can happen, whether from a large-scale breach or theft of an individual’s data. The result could be thousands of dollars in medical bills.
Medi-Cal’s Fragmented System Can Make Moving a Nightmare
When Medi-Cal beneficiary Lloyd Tennison moved last year from Contra Costa County to San Joaquin County, he was bumped off his managed care plan without notice before his new coverage took effect. His case highlights a chronic issue in California’s fragmented Medicaid program.
California’s Medicaid Experiment Spends Money to Save Money — And Help the Homeless
Gov. Gavin Newsom’s ambitious experiment in health care is supposed to cut costs as it fills the needs of hard-to-reach people. The program’s start is chaotic and limited, but it shows promise.
