Health plan tiers raise drug costs for hepatitis patients

By Bob Herman  |  October 05, 2015

A new report says that health insurance companies discriminate against people with hepatitis B and C by charging high out-of-pocket costs for drugs, but the industry lobby has called the analysis “very one-sided” and limited in scope.

Medicare Advantage star ratings to be released

By Bob Herman  |  October 03, 2015

The CMS will release 2016 star ratings for each Medicare Advantage plan on Thursday, and experts predict more insurers will receive higher quality scores as they adapt to the government's more rigorous standards.

Feds short insurers $2.5 billion on exchange plan losses

By Bob Herman  |  October 03, 2015

Health insurers that sold plans and lost money on the Affordable Care Act's exchanges in 2014 will receive only a portion of the $2.5 billion promised to them as safety-valve payments, a CMS official said last week.

ICD-10 earthquake caused barely a shake

ICD-10 earthquake caused barely a shake

By Joseph Conn and Bob Herman  |  October 02, 2015

Health information technology cognoscenti predict most large hospitals and health systems, physician groups and health plans can handle the numerous, complex and very specific new codes. Any cramps will appear later as providers' cash flows get hit by delayed reimbursements.

Is New York's duals demonstration on verge of collapse?

By Virgil Dickson  |  September 30, 2015

New York state's experiment to better coordinate care for low-income and disabled residents who are dually eligible for Medicaid and Medicare is losing hundreds of enrolled beneficiaries.

How drug prices and payment reform are changing the pharmacy benefit business

How drug prices and payment reform are changing the pharmacy benefit business

By Bob Herman  |  September 26, 2015

The pharmacy benefit management industry has been quietly changing amid healthcare payment reforms and an increasingly fierce debate over drug prices. Now a leadership shuffle at Express Scripts has experts speculating that the days of PBMs as stand-alone companies may be numbered.

Aetna wants to create health services unit from Humana assets

By Bob Herman  |  September 19, 2015

At an investor conference last week, Aetna Chief Financial Officer Shawn Guertin said the company intends to create a health services division with Humana's assets once their $37 billion deal was closed.

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