Insurance and Patients - Pharma Rep Focus

Therapists vs. Insurance: How AI Could End the Battle Over Mental Health Care

MedCity News

DECEMBER 11, 2024

With these tools, therapists can reclaim their time, focus on their patients, and deliver the high-quality care that every individual deserves all while maintaining the financial stability to thrive in their practices. The post Therapists vs. Insurance: How AI Could End the Battle Over Mental Health Care appeared first on MedCity News.

Insurance

Insurance Patients

Insurance companies putting profits ahead of patients

World of DTC Marketing

JUNE 1, 2022

Five of America’s largest health insurers reported more than $11bn in profits in the second quarter – a decline from the same period last year when the Covid-19 pandemic helped drive sky-high profits yet they are having more of a say on patients’ treatments even when HCPs disagree. Then there is prior authorization.

Insurance

Insurance Patients Doctors Physicians

Insurer “Delay and Deny” Practices Continue to Threaten Patients’ Timely Access to Gastrointestinal Care – It’s Time for Reform

MedCity News

MARCH 31, 2024

Insurers should immediately end their overreach into medical decision-making and work with medical providers and their patients to ensure timely care for all.

Insurance

Insurance Patients Medical

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American Hospital Association turns up the heat on commercial insurers in scathing report

MedCity News

AUGUST 9, 2022

Commercial insurers’ practices, such as prior authorization and white bagging, are needed to reduce costs for patients, said Kristine Grow, senior vice president of communications at AHIP.

Insurance

Insurance Patients Pharma

A Step Too Far: Congress Must Act on Insurance Company Tactics that Delay Critical Care for Patients

MedCity News

DECEMBER 17, 2023

This bipartisan legislation will help create a more transparent process that allows patients and physicians to seek exceptions to step therapy protocol. Although it only applies to employer-sponsored health plans, the bill represents an important step towards reining in this troubling practice.

Insurance

Insurance Patients Physicians

PBMs and insurers want your prescription money

World of DTC Marketing

JULY 27, 2022

anti-kickback law that the drugmaker said prevented it from helping heart failure patients, many with low incomes, afford the medicine that costs $225,000 annually. Health insurers have started effectively stealing co-pay coupons, leaving patients on the hook for far higher expenses. Let’s take a step back for a minute.

Insurance

Insurance Prescription Medicine Medical

Payers Are Putting Profit Over Patients with Denials and Prior Auth Policies, Hospitals Say

MedCity News

OCTOBER 6, 2024

Hospitals are facing increasingly burdensome policies from commercial insurers, leading to problems with cash flow and patient safety. The post Payers Are Putting Profit Over Patients with Denials and Prior Auth Policies, Hospitals Say appeared first on MedCity News.

Patients

Patients Insurance Safety Leads

How to Help Physicians Generate More Revenue and Make Their Patients Healthier

MedCity News

APRIL 2, 2024

Interest in using GLP-1 drugs to reduce obesity combined with a desire by physicians to become less dependent on insurance-based reimbursement after the recent Change Healthcare cyberattack is building. The post How to Help Physicians Generate More Revenue and Make Their Patients Healthier appeared first on MedCity News.

Physicians

Physicians Patients Insurance Healthcare

AstraZeneca staffers detained in China over patient data collection, drug imports: Bloomberg

Fierce Pharma

SEPTEMBER 5, 2024

AstraZeneca has found its employees’ practices under the microscope of Chinese law enforcement years after an insurance fraud case. AstraZeneca has found its employees’ practices under the microscope of Chinese law enforcement years after an insurance fraud case.

Insurance

Insurance Patients

White Bagging Policies Endanger the Lives of Cancer Patients

MedCity News

NOVEMBER 22, 2023

Insurers and PBMs are increasingly implementing white-bagging policies, which require oncology practices to obtain physician-administered infusions and other medications from designated specialty pharmacies often owned by or affiliated with insurers and their PBMs.

Insurance

Insurance Physicians Patients Medical

Making Pharmacy Benefits Transparent and Returning Control to Patients and Employers [Sponsored]

MedCity News

JANUARY 9, 2023

Transcarent wants to transform the digital pharmacy benefit experience, enabling self-insured employers and their staff to make more informed choices.

Insurance

Insurance Patients Prescription Management

Should doctors refuse to treat obese patients?

World of DTC Marketing

MARCH 28, 2021

IN BRIEF: Doctors are not required to treat obese patients who won’t do anything to lose weight but the problem is more than reminding patients they need to get exercise and drop pounds. But what about patients who make no effort to lose weight? Medicare and Medicaid patients specifically cost $61.8

Doctors

Doctors Patients Insurance Physicians

It’s Time for Healthcare To Embrace Patient-Friendly Language

MedCity News

JUNE 1, 2023

If organizations present medical records, cost data, and descriptions of billing codes to patients without providing context or stripping out medical jargon, then the information is potentially subject to regulatory penalties. That means providing more patient-friendly terminology is more than just a compliance checkbox.

Patients

Patients Healthcare Healthcare Electronics

Automating Insurance Verification: A Game-Changer for Pre-Visit Payment Collection

MedCity News

FEBRUARY 25, 2025

The operational benefits of automated eligibility and payment workflows are clear, but its impact on people both patients and staff may be even more profound. The post Automating Insurance Verification: A Game-Changer for Pre-Visit Payment Collection appeared first on MedCity News.

Insurance

Insurance Patients Healthcare Healthcare

Report: Firearm-related Injuries Cost US Healthcare $1B Annually

MedCity News

APRIL 25, 2023

healthcare system $290 million, or about $6,400 per patient, according to a report from the Commonwealth Fund. These costs are mostly covered by Medicaid and other government insurance programs. In just 2020, deaths from gun violence cost the U.S.

Healthcare

Healthcare Healthcare Insurance Government

19 Senators Urge HHS to Drop Appeal That Would Jeopardize Americans’ Access to Life-Saving Drugs

MedCity News

JANUARY 5, 2024

A bipartisan group of senators sent a letter to HHS asking it to rethink its appeal of a recent federal district court decision that limits the use of “copay accumulators” — which are programs insurers use to prevent medication copay assistance from counting toward patients’ deductibles or out-of-pocket maximums.

Insurance

Insurance Medical Patients Pharma

Correcting Provider Biases About Transgender and Gender Non-Conforming Patients Can Protect Their Health and Safety

MedCity News

SEPTEMBER 22, 2023

Providers, administrators, health insurers and other healthcare-access gatekeepers can learn, train, change policies and remove barriers facing vulnerable groups so they can receive the long-overdue opportunity to pursue their best health and well-being.

Safety

Safety Insurance Training Healthcare

The No Surprises Act and ‘Good Faith Estimate’: What Is It and When Is It Required

MedCity News

JANUARY 20, 2023

For patients that are uninsured or not using their insurance and choosing to pay out of pocket, providers are required to give a patient an estimate of all reasonably expected costs ahead of time, referred to as the Good Faith Estimate (GFE).

Insurance

Insurance Patients

‘It’s creating change’: How some startups are circumventing payers

MedCity News

SEPTEMBER 19, 2022

Many startups are giving patients options to receive care that cuts out insurers. This includes online pharmacies, direct primary care platforms and lending companies. These startups are creating change among payers, some experts say.

Insurance

Insurance Patients

In Cardiology, AI Enables Me to Deploy Therapy Faster, and Can Make the Difference Between Life and Death

MedCity News

NOVEMBER 26, 2023

I work as a cardiologist for a multi-specialty group that sees patients both in capitated payer and fee-for-service environments. This diverse practice gives me the experience to know where insurance providers will find value or what they will likely pay for.

Insurance

Insurance Healthcare Healthcare Patients

Senators, Representatives Introduce Bill That Would Ban Joint Ownership of PBMs and Pharmacies

MedCity News

DECEMBER 13, 2024

Senators Elizabeth Warren and Josh Hawley and Representatives Diana Harshbarger and Jake Auchincloss introduced the Patients Before Monopolies Act on Wednesday. It aims to prohibit the parent company of a PBM or insurer from owning a pharmacy business.

Insurance

Insurance Patients

Our abysmal health care system

World of DTC Marketing

AUGUST 7, 2022

The passage of the Inflation Control bill is an excellent first step in limiting high drug costs, but our healthcare system is still built for profit at the expense of patients. First, the health insurance companies are making a lot of money while burying doctors in paperwork and limiting treatment options.

Insurance

Insurance Doctors Government Physicians

Cigna extends coverage for Brainsway’s brain stimulation device to treat OCD

MedCity News

SEPTEMBER 17, 2022

Israeli medical device company Brainsway earned a positive coverage policy from Cigna for its deep transcranial magnetic stimulation to treat adult patients with OCD. Cigna joins the ranks of other major insurers who cover the device for OCD treatment — including Centene, Highmark, Blue Cross Blue Shield, Tricare and Palmetto GBA.

Insurance

Insurance Medical Patients

Amazon Exec: We Love Innovation, But We Don’t Love to Talk About Who Pays for It

MedCity News

DECEMBER 4, 2023

But when talking about these innovations, healthcare leaders often fail to address questions about whether they will be covered by insurance and whether all patients will be able to benefit from them, he pointed out.

Insurance

Insurance Medical Healthcare Healthcare

Novo’s obesity drug has serious warnings and barriers to overcome

World of DTC Marketing

JUNE 6, 2021

SUMMARY: The media headlines promise weight loss for diabetes patients, but Norvo’s new drug is in the same class as other drugs and carries many warnings. Can diabetes patients really stay adherent to a drug for 63 weeks in which 85% of patients report GI side effects and will insurance cover the cost?

Side effects

Side effects Insurance Medical Patients

The Healthcare System Isn’t a System, Health Exec Says

MedCity News

APRIL 19, 2023

Patients are struggling to find the right care, and that’s because the healthcare system is fragmented, according to Andrea Walsh, president and CEO of HealthPartners, an integrated healthcare provider and insurance company. Walsh made these comments Wednesday at the HIMSS 2023 conference in Chicago.

Healthcare

Healthcare Healthcare Healthcare Provider Insurance

With ‘bold experiment’ in drug pricing, Arcutis aims to stand out in plaque psoriasis

MedCity News

AUGUST 1, 2022

With the decision, the company will proceed with a pricing strategy it believes will speed up insurance coverage and patient adoption of the new treatment for the chronic inflammatory skin disorder. The FDA approved Arcutis Biotherapeutics drug Zoryve, a topical treatment for plaque psoriasis.

Insurance

Insurance FDA Patients Biopharma

Headway Raises $125M, Reaches Unicorn Status

MedCity News

OCTOBER 5, 2023

The company connects patients to in-network therapists and helps mental health providers avoid the massive administrative burden associated with taking insurance. The round brings the New York-based startup’s valuation to $1 billion, reaching unicorn status.

Insurance

Insurance Networking Patients

Pediatric mental health startup launches with $26M and a vow to scale Mass General’s proven care model

MedCity News

OCTOBER 7, 2022

InStride Health — a virtual care provider for pediatric patients with moderate to severe anxiety and OCD — recently launched with $26 million in funding. The startup delivers insurance-covered pediatric mental health treatment using a care model developed by two of its co-founders, who are Mass General Brigham clinicians.

Insurance

Insurance Patients

Geisinger CEO: Price variability won’t be solved unless payers & providers get on the same page

MedCity News

OCTOBER 20, 2022

Price transparency data has revealed there is a high degree of price variance for healthcare procedures depending on patients’ insurance carriers and the location in which services are delivered.

Insurance

Insurance Healthcare Healthcare Patients

The financial toxicity of treating cancer

World of DTC Marketing

JANUARY 4, 2022

(Stat News) Today, a study followed 380 patients being treated at community oncology groups across the U.S. They told the researchers that insurance didn’t protect them from serious money problems. Cancer patients may struggle to pay out-of-pocket expenses due to the high expenses incurred, the medical debt, or loss of work.

Insurance

Insurance Transportation Medical Medicine

Why Consumers Leave Their Payer/Provider

MedCity News

MAY 9, 2024

Many consumers leave their provider because of navigation problems, while many leave their insurer because of experience issues, a new Accenture report found. The post Why Consumers Leave Their Payer/Provider appeared first on MedCity News.

Insurance

Insurance Patients

Government issues final rules to prevent surprise medical bills

MedCity News

AUGUST 24, 2022

Following litigation battles and multiple iterations of the Act, the final rules address the arbitration process for insurers and provide more transparency for patients.

Government

Government Insurance Medical Patients

‘We Can Be More Selective About Who We Treat’: UHS CFO’s Comments Spark Concerns About Cherry-Picking

MedCity News

AUGUST 1, 2023

Last week, the CFO of Universal Health Services stated that the company chooses which patients to treat based on whose insurance plans offer the highest payments. The comments have sparked some media attention, but healthcare finance experts say the practice of cherry-picking patients is nothing new to the industry.

Insurance

Insurance Media Healthcare Healthcare

The Urgent Care Crisis of Low Reimbursement: A Looming Threat to Accessible Healthcare

MedCity News

JULY 27, 2023

I invite insurance companies to engage in meaningful dialogue with urgent care providers to understand the challenges they face and explore fair reimbursement models that reflect the value they bring to patients.

Insurance

Insurance Healthcare Healthcare Patients

Um, about that diabetes drug that helped patients lose weight

World of DTC Marketing

JUNE 27, 2021

Yet the media has led with “diabetes drug leads to major weight loss” Will doctors inform patients? Wegovy’s most common side effects were gastrointestinal problems, including nausea, diarrhea, and vomiting, which 80% of patients reported, according to USA Today. appeared first on World of DTC Marketing.com.

Side effects

Side effects Patients Insurance Doctors

Eisai backs Leqembi’s Japan rollout with insurance policy

pharmaphorum

MARCH 21, 2024

A partnership between Eisai and Lifenet that aims to improve insurance cover for people with early dementia has generated its first policy, part of an effort by the pharma group to develop an ‘ecosystem’ to support patients.

Insurance

Insurance Pharma Patients

Bluebird bio's gene therapy fertility support program gets thumbs down from HHS inspector general

Fierce Pharma

JULY 22, 2024

The Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) has published an unfavorable opinion in response to bluebird’s request for an advisory review of the program.

Insurance

Insurance Patients

No Surprises Act Leads to Thousands More Disputes and Delays than Gov’t Expected

MedCity News

NOVEMBER 21, 2022

When the federal government enacted the No Surprises Act to lessen payment disputes between a patient or a health insurance plan and a provider, the government projected 22,000 disputes in 2022. However, between just April and September there were more than 90,000 disputes filed. .

Leads

Leads Government Insurance Patients

Cell and Gene Therapies Push Payers to New Strategies to Assess Outcomes

MedCity News

NOVEMBER 16, 2022

Cell and gene therapies are offering patients potentially curative treatments for a growing scope of diseases. Insurance companies are trying to figure out how to pay for them. Industry consultants speaking at the HLTH conference offered some strategies they see payers taking to these new therapies.

Insurance

Insurance Consulting Patients Biopharma

It’s Time To Ask What Comes After 988

MedCity News

FEBRUARY 27, 2023

The mental health ecosystem is fragmented and lacks effective tools to help patients find and engage the right providers for their insurance and their clinical needs, both before and after they call 988. The launch of the 988 hotline was a massive win for mental healthcare in America, but it’s only the first step.

Insurance

Insurance Healthcare Healthcare Patients

Breaking Down Patient Access Barriers

PM360

DECEMBER 20, 2024

After nearly five years of mounting pressures on the American healthcare system, providers and patients are confronting another challenge that shows no signs of slowing down: skyrocketing medical costs. Patients with low incomes are especially vulnerable.

Patients

Patients Prescription Retail Insurance

Everything You Need to Know About Prior Authorizations in Healthcare

Referral MD

DECEMBER 9, 2024

Prior authorization is a pivotal component of healthcare, bridging the relationship between patients, healthcare providers, and insurance companies. While a physician may determine a treatment plan, they must get the insurers green light to ensure coverage. Photo by terovesalainen on Adobe Stock What Is Prior Authorization?

Healthcare

Healthcare Healthcare Insurance Healthcare Provider

Free Prescription Drugs Are Often Available—If Only Your Doctor Can Find Them

MedCity News

MARCH 13, 2023

Price transparency has come a long way over the past couple of years, with insurance companies and hospitals now required to publicly disclose their prices. The more pressing issue is that there is no mechanism in place to make this information easily digestible, personalized to each patient, and placed in context with competitors’ prices.

Doctors

Doctors Prescription Insurance Patients

Therapists vs. Insurance: How AI Could End the Battle Over Mental Health Care

Insurance companies putting profits ahead of patients

Webinars

Trending Sources

Insurer “Delay and Deny” Practices Continue to Threaten Patients’ Timely Access to Gastrointestinal Care – It’s Time for Reform

Webinars

American Hospital Association turns up the heat on commercial insurers in scathing report

A Step Too Far: Congress Must Act on Insurance Company Tactics that Delay Critical Care for Patients

PBMs and insurers want your prescription money

Payers Are Putting Profit Over Patients with Denials and Prior Auth Policies, Hospitals Say

How to Help Physicians Generate More Revenue and Make Their Patients Healthier

AstraZeneca staffers detained in China over patient data collection, drug imports: Bloomberg

White Bagging Policies Endanger the Lives of Cancer Patients

Making Pharmacy Benefits Transparent and Returning Control to Patients and Employers [Sponsored]

Should doctors refuse to treat obese patients?

It’s Time for Healthcare To Embrace Patient-Friendly Language

Automating Insurance Verification: A Game-Changer for Pre-Visit Payment Collection

Report: Firearm-related Injuries Cost US Healthcare $1B Annually

19 Senators Urge HHS to Drop Appeal That Would Jeopardize Americans’ Access to Life-Saving Drugs

Correcting Provider Biases About Transgender and Gender Non-Conforming Patients Can Protect Their Health and Safety

The No Surprises Act and ‘Good Faith Estimate’: What Is It and When Is It Required

‘It’s creating change’: How some startups are circumventing payers

In Cardiology, AI Enables Me to Deploy Therapy Faster, and Can Make the Difference Between Life and Death

Senators, Representatives Introduce Bill That Would Ban Joint Ownership of PBMs and Pharmacies

Our abysmal health care system

Cigna extends coverage for Brainsway’s brain stimulation device to treat OCD

Amazon Exec: We Love Innovation, But We Don’t Love to Talk About Who Pays for It

Novo’s obesity drug has serious warnings and barriers to overcome

The Healthcare System Isn’t a System, Health Exec Says

With ‘bold experiment’ in drug pricing, Arcutis aims to stand out in plaque psoriasis

Headway Raises $125M, Reaches Unicorn Status

Pediatric mental health startup launches with $26M and a vow to scale Mass General’s proven care model

Geisinger CEO: Price variability won’t be solved unless payers & providers get on the same page

The financial toxicity of treating cancer

Why Consumers Leave Their Payer/Provider

Government issues final rules to prevent surprise medical bills

‘We Can Be More Selective About Who We Treat’: UHS CFO’s Comments Spark Concerns About Cherry-Picking

The Urgent Care Crisis of Low Reimbursement: A Looming Threat to Accessible Healthcare

Um, about that diabetes drug that helped patients lose weight

Eisai backs Leqembi’s Japan rollout with insurance policy

Bluebird bio's gene therapy fertility support program gets thumbs down from HHS inspector general

No Surprises Act Leads to Thousands More Disputes and Delays than Gov’t Expected

Cell and Gene Therapies Push Payers to New Strategies to Assess Outcomes

It’s Time To Ask What Comes After 988

Breaking Down Patient Access Barriers

Everything You Need to Know About Prior Authorizations in Healthcare

Free Prescription Drugs Are Often Available—If Only Your Doctor Can Find Them

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