The Health Care Financing Administration has ordered Medicaid to cover Serostim, a growth hormone that can stifle cachexia — also known to AIDS patients as wasting.... Two New York representatives have introduced a measure in Congress that would require health plans to cover routine breast, cervical, colorectal, and prostate cancer screenings under Medicare's screening-benefit schedule.... Florida legislators were to consider compromise legislation in late April mandating coverage of bone-marrow transplants, autism-spectrum disease, and oral contraceptives, all of which would add $40 million to costs, HMOs say.... The California legislature is considering a similar bill regarding coverage of oral contraceptives.... Meanwhile, California officials have told Health Net not to cut 14 drugs from its formulary, including Prozac and two drugs for cystic fibrosis that patient groups say have no adequate substitutes.
Managed Care’s Top Ten Articles of 2016
There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.
They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?
A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.
More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.