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CMS cites Aetna in 1st No Surprises Act audit https://www.beckerspayer.com/payer/cms-cites-aetna-in-1st-no-surprises-act-audit.html Aetna failed to accurately calculate qualified payment amounts for air ambulance services, CMS’ first audit of an insurer’s No Surprises Act compliance found. The audit, issued May 29, examined the rates Aetna Health in Texas charged for an out-of-network air ambulance provider between January and […]
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House committee hears from FTC commissioners on PBM report https://ncpa.org/newsroom/qam/2024/07/11/house-committee-hears-ftc-commissioners-pbm-report On Tuesday—the same day the agency released its interim report on PBMs—the five FTC commissioners testified before the U.S. House Committee on Energy and Commerce on their FY25 budget request. Numerous committee members wanted to hear from the commissioners about the new report, however. Rep. […]
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If you have traditional Medicare, the vendor is required to notify the pt up front that Medicare is not expected to pay for the product/procedures, and the pt understands that they are responsible for costs associated with the product/procedure provided. That is called an Advance Beneficiary Notice of Non-coverage, https://www.medicare.gov/basics/your-medicare-rights/your-protections if the pt was not […]
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Back in the day… before there was NO PBM industry. I remember it being reported that Rx costs were about 6% of total healthcare expenditures. The PBM industry was a result of an AUW contract at the end of 1969. I don’t remember, but probably the effective date was the first of 1970. Back then, […]
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Thinking Out Loud: The Chevron Doctrine https://www.acsh.org/news/2024/07/03/thinking-out-loud-chevron-doctrine-48846 Thank God for the Supreme Court. If not for their reversal of the Chevron doctrine, we would continue to be subject to the regulatory whims of a faceless, often agenda-driven, unelected bureaucracy. With a sweep of its magisterial pen, the justices have turned over the fine details that […]
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FTC Releases Interim Staff Report on Prescription Drug Middlemen https://www.ftc.gov/news-events/news/press-releases/2024/07/ftc-releases-interim-staff-report-prescription-drug-middlemen The Federal Trade Commission today published an interim report on the prescription drug middleman industry that underscores the impact pharmacy benefit managers (PBMs) have on the accessibility and affordability of prescription drugs. The interim staff report, which is part of an ongoing inquiry launched in […]
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If “we” end up with “Medicare for all” or some form of “universal healthcare system” Could this be the template for such a program? Does anyone believe that our private health insurance industry would be against that or would they throw untold $$$ into hiring lobbyists to help ensure that Congress goes down the path […]
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I don’t agree with this author’s opinion of what the overturning of Chevron doctrine is going to do to necessarily harm our society’s health. One of the biggest generators of CO2 is the biological functions of most organisms’ metabolism. One thing that appears that could happen is that the DEA will have its hands tied […]
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Two dozen members of Congress sent a letter recently to the assistant secretary of defense for health affairs and the director of the Defense Health Agency regarding concerns about Express Scripts and how it’s running the Tricare pharmacy program. Led by Sen. Elizabeth Warren (D-Mass.) and Rep. Buddy Carter (R-Ga.), the letter highlights that the […]
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