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.
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.
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.
Big Bend Regional Medical Center, the only hospital in a sparsely populated region of West Texas, announced that because of a nursing shortage its labor and delivery unit must close for days at a time and patients must go instead to a hospital an hour away.
The Supreme Court, come autumn, will consider a Mississippi law that bans nearly all abortions after 15 weeks of pregnancy. That’s hardly the most restrictive abortion law passed in the South. How did anti-abortion views become concentrated in the South?
California Gov. Gavin Newsom faces a recall election in September, fueled in part by anger over his pandemic policies. The health care industry has ponied up more than $4.8 million so far to defend the first-term Democrat.
The state says it will look at the levels of disease-fighting antibodies among nursing home residents vaccinated against covid, which could help indicate whether they need a booster shot.
