Unlocking Transparency in PBM Pricing
Dan Reedy, senior director of pricing and underwriting for Abarca, spoke recently with MedCity News about what payers should consider as they explore new models and press for greater transparency.
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Navigating Policy Terrain: Perspectives for Payers on Tackling Ghost Networks
Lawmakers have ghost networks in their sights, and payers can prepare now for policy changes.
Unlocking Transparency in PBM Pricing
The TSX Venture Exchange has a strong history of helping early-stage health and life sciences companies raise patient capital for research and development.
To Continue the Momentum in Women’s Health, We Have No Time to Lose
We must look both “upstream” – at advocating for change on an institutional level – and “downstream” – at what we can do as individuals to help women secure the care they need.
The globally declining birth rate and the role of egg freezing
Depopulation places an unsustainable burden on a diminishing workforce, as fewer workers are available to support an increasing number of seniors. But technological improvements in egg freezing have resulted in vastly improved pregnancy rates and could help slow the decline in births.
BrightInsight CEO Kal Patel M.D. discusses the future of regulated digital health for biopharma and medtech
In order to benefit from the Virtual1Care trend, pharma and medtech companies must ensure that their digital health tools, wrapped around a drug or device, comply with evolving regulations.
A preview of MedCity INVEST 2022: A return to in-person conferences
INVEST, scheduled for March 28-30, 2022 in Chicago, marks a return to in-person events for MedCity News. The conference, held in partnership with Mid-America Healthcare Investors Network, will spotlight healthcare innovation, investment trends, and share insights from healthcare executives.
The Impact Brands: Empowering Wellness Through Natural and Holistic Solutions
In an era of escalating healthcare costs and a growing preference for natural, holistic approaches to health, The Impact Brands emerges as a collective of diverse brands dedicated to supporting overall wellness through natural means.
CMS scraps coverage rule for breakthrough devices
The agency decided to rescind a rule by the previous administration where Medicare would be required to cover breakthrough devices for up to four years after they receive FDA approval or clearance. CMS said it made the change to address safety concerns with the policy.
HIMSS Digital experts: Providers may once again face a ‘labyrinth’ of telehealth policies
Emergency rules during the Covid-19 pandemic have streamlined telehealth reimbursement and widened access. But after these flexibilities lift, experts said providers could face a maze of different licensing requirements and reimbursement rates.
Regulated digital health explained: What you need to know to stay compliant
Digital health thought leader Mark Tarby, BrightInsight vice president of regulatory and quality management systems, shared his take on what the EU MDR means for connected devices, Software as a Medical Device (SaMD), and the go-to market strategies for the companies behind them.
UnitedHealthcare nixes some out-of-network coverage for non-emergencies
Per a policy update that went in to effect July 1, the health insurance giant is not covering non-emergency services that members receive at out-of-network facilities that are outside of their service area. This update mainly affects residential treatment facilities, inpatient rehabilitation and other non-hospital-based services.
At ViVE 2024, Panelists Share Prior Authorization Progress and Frustration in Payer Insights Program
At the Payer Insights sessions on Day 1 of ViVE 2024, a panel on prior authorization offered compelling insights from speakers who shared the positive developments in this area after years of mounting frustration. Speakers also shared challenges as they work with providers to figure out how policy developments and technology will work in practice.
Emergency physicians oppose new UnitedHealth policy enabling retroactive ED claims denial
UnitedHealthcare is instituting a new policy beginning July 1 that changes how the payer assesses emergency department claims, allowing it to retroactively deny ones it deems "non-emergent" or not an emergency. The American College of Emergency Physicians has made its opposition clear, stating the policy may violate federal law.
100+ workers sue Houston Methodist over mandatory Covid-19 vaccination policy
The lawsuit alleges that the policy is akin to forcing employees to participate in a medical experiment as none of the vaccines available have received full FDA approval. But Houston Methodist rebutted these claims saying the vaccines are safe and effective, and requiring employees to get vaccinated is in the best interest of the patient.
3 changes coming to drug pricing
No matter if Democrats or Republicans are running the show in Washington, here are three solid bets for pharma companies to plan for in the changing drug-pricing landscape
People in wealthy, urban areas saw the biggest increase in telehealth use
While telehealth use soared last year, the biggest increases were among adults living in metropolitan areas with low poverty levels, according to research published in the American Journal of Preventive Medicine.
CMS rule requires insurers to cover tests for asymptomatic patients
A new CMS rule would require insurers to cover Covid-19 tests, even for asymptomatic patients. It builds on previous legislation requiring payers to cover the cost of both testing and vaccines for their members.