Claims denials and appeals in ACA marketplace plans: Kaiser Family Foundation

Claims denials and appeals in ACA marketplace plans: Kaiser Family Foundation

“In this report, we analyze transparency data released by the Centers for Medicare and Medicaid Services (CMS) to examine claims denials and appeals among issuers offering individual market coverage on healthcare.gov from 2015-2017,” Karen Pollitz, Cynthia Cox and Rachel Fehr write for the Kaiser Family Foundation, in a startling analysis of federal data that reveals […]

Do PBMs Delay Drugs and Drive Up Drug Prices? – The Atlantic

Do PBMs Delay Drugs and Drive Up Drug Prices? – The Atlantic

“Lynn Lear finished her final round of chemotherapy for breast cancer in December. To help keep the cancer from coming back, Lear’s doctor told her about a new medication she could take called Nerlynx. Lear, who is 46, wanted to do everything she could to remain healthy, so she asked her doctor to order the […]