Pharmacy benefit managers have curtailed in-person audits of pharmacy claims during the pandemic, switching to virtual audits done by computer. That has markedly increased the number of claims they can review — and the chances for payment denials — squeezing pharmacies and bringing in more cash for the benefit companies.
Covid is back with a vengeance, with some people clamoring for booster shots while others harden their resistance to getting vaccinated at all. Meanwhile, the Food and Drug Administration is pushing hard on drugmaker Pfizer’s request to upgrade the emergency authorization for its vaccine and give it final approval. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, for “extra credit,” the panelists suggest their favorite health policy stories of the week they think you should read, too.
The Medicare rule, designed by the Trump administration to take money away from drug industry brokers and provide refunds to patients, has not been implemented. But budget analysts say if it were, it would cost the government money. So senators are pushing the rule aside and claiming to save billions of dollars, which they want to use instead on new projects.
State health officials say the federal government will likely reject any work or community engagement requirements, which were key to Republican lawmakers agreeing to extend the program that insures 100,000 low-income Montana adults.
Providence, the country’s 10th-biggest hospital chain, says it’s too expensive to upgrade an older hospital, so it will join forces with giant Kaiser Permanente to build a new one.
The success in getting shots to older adults is likely due to states prioritizing that effort when the vaccines became available and motivation among the elderly after the virus killed so many in their age group.
Health insurers could do more to encourage vaccination, including letting the unvaccinated foot their bills.
Community Health Systems, a large, for profit hospital chain, shrank from more than 200 to 84 facilities. It is continuing to sue patients for hospitals that now exist as little more than legal entities.
Restrictive abortion regulations enacted across the South require women to drive across state lines to find safe services. With the U.S. Supreme Court set to hear a challenge to Roe v. Wade, abortion rights defenders say long drives and wait times could become the norm across much of America.
The pandemic forced new parents to find help with breastfeeding online. Now, some offerings are remaining virtual to help expand access to lactation support.
