Pre-reform underwriting approaches for speciality medications like HIV/AIDS drugs are not going to fly in the new health insurance market, as regulators and patient advocates intervene to challenge a range of practices.
Cost-sharing in traditional Medicare is on the rise, and benefit designs in Medicare drug plans are changing.
The new hepatitis C treatment Sovaldi has driven debate over drug costs for close to a year, but it’s also been a case study in access and coverage in public payer programs.
Drug benefits stand as some of the most consequential consumer confusions that can arise in public exchanges, increasing the onus on insurers to improve the design and explanation of formularies.
A shrinking number of Medicare Part D drug plans is set to bring beneficiaries some more low-cost choices, but also some potentially confusing benefit designs.
Struggling Medicare Advantage and Part D drug plans are being given a last minute reprieve, although they will need to show more improvement if they want to stay alive longer than a year.
UnitedHealth Group's big data venture is plying new waters in deals with several powerful healthcare institutions, trying to create value with one of healthcare's largest databases.
The currents of health reform and consumerization are getting more treacherous for incumbent hospital businesses, but payers and retailers, especially, have waves to ride.
The pharmacy benefits industry is challenging a new state law, trying to protect a key management tool that insurers, employer groups and public payers have been relying on for cost stability.
Insurers may need to find new ways to control costs for specialty drugs, as more states add limits to cost-sharing and utilization continues to grow.
A once-promised truth in pharmaceutical benefits management is unravelling, leaving payers exposed and researchers scratching their heads.
Amid challenging trends in drug prices and formularies, independent pharmacy advocates are pushing for a new "any willing" provider mandate in Medicare Part D.
Uncertain future for Medicaid private option
How are HIXs going to sustain themselves?
Regulatory probe hits network adequacy
Large duals demo faces backlash
Humana boosts retail strategy with new payment option
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