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7 ways health plans are containing weight loss drug costs
Around 6 in 10 health plans have provider education in place to promote alternative options to costly GLP-1 drugs like Ozempic and Wegovy for obesity and diabetes treatment, according to a survey from diabetes management provider Virta Health. -
CMS introduces Medicare dementia care alternative payment model
CMS is launching a new Medicare alternative payment model designed to help people with dementia remain in their homes and provide better support to their caregivers. -
Cancer screenings double when patients receive Medicare, Epic research finds
Patients are more likely to receive cancer screenings in their first year of Medicare coverage than in previous years, a study from Epic Research found. -
US Labor Department sues UnitedHealth Group over emergency claims denials
UnitedHealth Group subsidiary UMR incorrectly denied emergency room and urinary drug screening claims for 'thousands," the U.S. Department of Labor alleges in a lawsuit filed July 31 in a Wisconsin federal court. -
Representatives unveil Medicare Advantage gold-card legislation
Two U.S. representatives have introduced gold-card legislation that would exempt qualifying providers from prior authorization requirements for Medicare Advantage plans. -
CMS projects slightly lower Medicare Part D premiums in 2024
CMS is projecting Medicare Part D premiums to decrease by 1.8 percent in 2024, the agency said in a July 31 news release. -
13 states where more than half of dual-eligible people choose Medicare Advantage
Around half of beneficiaries dually-eligible for Medicare and Medicaid are enrolled in Medicare Advantage, according to a July 31 analysis from KFF. -
Health plans are dropping weight loss drugs like flies
As demand for GLP-1s such as Ozempic and Wegovy continues to surge, payers and self-insured employers are dropping coverage for the weight loss medications left and right. -
Martin's Point Health to pay $22.5M to settle alleged Medicare Advantage fraud
Portland, Maine-based Martin's Point Health Care has agreed to pay $22.5 million to resolve allegations that it knowingly submitted inaccurate diagnosis codes for Medicare Advantage Plan enrollees to increase reimbursements from Medicare. -
Elevance Health to rebrand Amerigroup as Wellpoint
Elevance Health is rebranding its Amerigroup subsidiary as Wellpoint. -
54,000 enrolled in Marketplace coverage in first month of Medicaid redeterminations
Federal and state-based insurance marketplaces received around 140,000 applications from people who previously had Medicaid coverage in April, according to data from CMS. -
Centene could lose its last 4-star Medicare Advantage contract
Centene could end 2023 with no four-star rated Medicare Advantage contracts, CEO Sarah London told investors on a July 28 call. -
California to eliminate asset tests for Medicaid
CMS has approved a proposal from California to eliminate asset tests for Medicaid eligibility. -
Centene loses 263,000 Medicaid members in 1st months of redeterminations
Early data from Medicaid redeterminations is in line with Centene's expectations for membership losses, executives told investors. -
Medicaid disenrollments within expected range, Molina CEO says
Molina Healthcare's Medicaid membership declined 93,000 in the second quarter, which was well within expectations, CEO Joe Zubretsky said on the company's July 27 earnings call, according to a transcript from Seeking Alpha. -
Medicare Advantage in the headlines: 9 recent updates
Payers are seeing rising costs in the Medicare Advantage population, and lawmakers are proposing reforms to the program's prior authorization process. -
Centene posts $1.1B profit in Q2
Centene recorded $1.06 billion in net income in the second quarter of 2023 after recording a $172 million loss during the same period last year, according to the company's earnings report released July 28. -
Disenrollment pause results in 15,000 additional Medicaid renewals in Michigan
Michigan will give Medicaid enrollees an extra month to return enrollment forms before their coverage is terminated through 2024, the state's department of health and human services said July 26. -
Nevada is last state to liquidate Friday Health Plans
Nevada will liquidate Friday Health Plans, making it the last of the seven states to shut down the defunct payer. -
North Carolina sets Medicaid expansion start date, but funding in limbo
North Carolina Gov. Roy Cooper's administration has said the state's Medicaid expansion will take effect Oct. 1, but the Legislature has not approved the funding needed to launch the program, Politico reported July 26.
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