“Patients are not hot potatoes”: How the fight over dialysis coverage is putting kidney failure patients at risk
As soon as she heard the Supreme Court decision, LaVarne Burton began to worry. As…
Category: Medicare
STAT+: Option Care takes over Amedisys in ‘perplexing’ $3.6 billion home care deal
Option Care Health is buying Amedisys in an all-stock merger valued at $3.6 billion, creating…
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STAT+: New Eli Lilly Alzheimer’s data poses Medicare coverage conundrum
WASHINGTON — Eli Lilly’s latest anti-amyloid Alzheimer’s treatment seems to slow the disease, the company announced…
STAT+: Disagreements and digs upend an otherwise bipartisan hearing on PBM reform
WASHINGTON — The first Senate health committee markup under Chairman Bernie Sanders (I-Vt.) and ranking…
STAT+: Bright Health looks to get out of health insurance entirely
Bright Health Group started as a health insurance company. But it will no longer be…
STAT+: Health insurance CEOs set another record for pay in 2022
Business has never been better for the largest health insurers in the country, which led…
STAT+: Medicare official insists drug price negotiation will consider value of drugs
WASHINGTON — When Medicare starts negotiating drug prices, it will take into account how important…
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STAT+: How a small hospital in Nebraska has thrived through the pandemic
Great Plains Health is a small hospital system in a part of Nebraska surrounded by…
STAT+: Pharmalittle: White House to tap cancer center chief to lead NIH; generic abortion pill maker sues FDA
Top of the morning to you. Gray skies are hovering over the Pharmalot campus right…
STAT+: Congress targets reducing hospital outpatient payments in new bills
WASHINGTON — House Republicans are floating several draft bills that would significantly affect the hospital…
STAT+: PhRMA execs paint grim picture of industry under Medicare drug price negotiation
WASHINGTON — Executives for the brand drug industry’s biggest lobbying group painted a grim picture…
STAT+: UnitedHealth says medical costs aren’t soaring. The reality is murkier
Executives at UnitedHealth Group hinted Friday that hospitalizations are not rising and that people are…
STAT+: Medicare advisers endorse reforms to lower drug spending
In the latest move to address prescription drug pricing, the Medicare Payment Advisory Commission unanimously…
STAT+: Just how big of a pay bump do hospitals need from Medicare next year?
The federal government is proposing to give hospitals a 2.8% raise in their Medicare payments…
STAT+: Wall Street embraces health insurers after scoring Medicare Advantage payment win
Health insurance companies that participate in Medicare Advantage will retain billions of extra taxpayer dollars…
STAT+: Medicare Advantage plans will have to stop denying required care, federal officials say
The Biden administration is moving forward with proposals that would crack down on Medicare Advantage…
STAT+: Biden administration goes easy on Medicare Advantage insurers after intense industry lobbying
WASHINGTON — The Biden administration backed off some of its plans to rein in billions…
Republicans press Becerra on gender-affirming care, reproductive rights
WASHINGTON — Republicans hammered the health secretary in hearings Tuesday, previewing a line of health-…
STAT+: Could a fight over cost-effectiveness upend Medicare drug price negotiation before it’s begun?
WASHINGTON — As Medicare drug price negotiation looms, congressional Republicans are scrambling to push through…
STAT+: Wary of changes to Medicare Advantage, health insurers put up a fight — and exaggerate the stakes
For the past two months, the health insurance industry has attempted to scare older adults…
STAT+: Key senators blast Medicare Advantage insurers for ‘exorbitant salaries,’ ‘massive payouts’ to execs
WASHINGTON — Sens. Elizabeth Warren (D-Mass.) and Jeff Merkley (D-Ore.) slammed seven different Medicare Advantage…
STAT+: A new Medicare ruling could give virtual reality companies an easier path to payment
The path to payment for virtual reality companies working in health care just became slightly…
STAT+: Hospitals are not crumbling, Medicare experts tell Congress
Hospitals’ financial situations are not nearly as dire as industry groups are making them out…
Listen: SVB’s long biotech shadow, pushy AI algorithms, & Icahn v. Illumina
Is AI dictating patient care? What happens when your bank falls apart? And can Illumina…
STAT+: The big-money Medicare policy that has hospitals worried this Congress
WASHINGTON — There are few things that get lawmakers in Washington salivating more than a wonky…
STAT+: Medicare explains how it will choose drugs for negotiation
WASHINGTON — Medicare laid out Thursday in the greatest detail yet how it will choose…
STAT+: Would the federal government defer to states to regulate PBMs?
WASHINGTON — After years of struggling to regulate the drug middlemen that create pharmacy networks,…
STAT+: Biden administration to fine manufacturers of 27 medicines for price hikes
WASHINGTON — The Biden administration will fine drugmakers who hiked prices faster than the rate…
STAT+: PhRMA chief dings health insurers over drug prices at their own conference
WASHINGTON — The head of the brand drug lobby used an in-person health insurance industry…
STAT+: Buyer’s remorse: How a Medicare Advantage business is strangling one of its first funders
When NaviHealth began building a business around using algorithms to scrutinize the care of older…
Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need
An algorithm, not a doctor, predicted a rapid recovery for Frances Walter, an 85-year-old Wisconsin…
Covering new weight loss drugs could strain Medicare, policy experts warn
The emergence of highly effective obesity drugs has spurred renewed efforts to get Medicare to…
STAT+: Medicare will take R&D costs, effectiveness into account when it negotiates drug prices. But studies show that doesn’t affect prices
By law, Medicare will have to take a medication’s efficacy and its research and development…
STAT+: An unlikely new 340B alliance emerges between PhRMA and community health centers
WASHINGTON — An unusual new alliance of the brand-drug lobby PhRMA and community health centers…
STAT+: Medicare chief on the new drug price negotiation program’s operations, hiring, and timelines
WASHINGTON — Medicare officials are still hammering out the technical specifics of how the massive…
Biden proposes expanding Medicare drug negotiation program
WASHINGTON — The Biden administration will propose expanding Democrats’ new drug pricing law by allowing…
STAT+: Biden administration floats major 2024 pay cut for Medicare Advantage plans
Medicare Advantage insurers could face an average 2.3% cut to baseline payments in 2024, the…
STAT+: Medicare Advantage insurers will score $2 billion gift thanks to limited audits
Medicare officials made a clear statement four years ago about how best to audit the…
STAT+: Medicare may test policy of paying less for accelerated approval drugs
A Medicare official hinted Tuesday that Medicare might test a policy of paying less for…
STAT+: Medicare Advantage insurers to repay billions under final federal audit rule
The federal government will audit Medicare Advantage insurers aggressively under a rule finalized Monday, which…
STAT+: ‘Everybody has blood on their hands’: A decade-long battle over Medicare Advantage audits is coming to a head
The federal government and health insurance companies have been clashing for more than a decade…
HHS’ Becerra on enrolling in Medicare, annual Covid vaccines, and seniors’ mental health
WASHINGTON — The hottest birthday spot in town: A Hispanic senior center in northwest D.C….
STAT+: The unexpected alliance lobbying for Medicare to pay for new obesity drugs
WASHINGTON — It’s not every day that the pharmaceutical industry, the NAACP, a cancer center, and…
STAT+: Health groups like AHA, PhRMA channeled millions into end-of-year legislative debates
WASHINGTON — Health care groups and their lobbyists spent big in the last few months…
Opinion: Upcoding: one reason Medicare Advantage companies pay clinicians to make home health checkups
At the start of 2023, an estimated 2.5 million Americans age 65 and older began…
STAT+: Hip and knee replacements go better when performed by high-volume surgeons, new study finds
A new study underscores the importance of the adage “practice makes perfect,” especially when it…
STAT+: Hospitals gear up to expand market power, raise prices in 2023
SAN FRANCISCO — More than a dozen of the country’s large not-for-profit hospital systems descended…
STAT+: Congressional Medicare advisers warn of higher drug prices, despite new price negotiation
WASHINGTON — Despite the pharmaceutical industry’s loud complaints to the contrary, the new law directing…
STAT+: Oscar Health’s CEO on post-hype health insurance and finally turning a profit
Oscar Health has excelled at one thing in particular since its inception a decade ago:…
STAT+: Medicare paves the way for CAR-T in doctors offices
WASHINGTON — Medicare officials have taken a step toward making a cutting-edge cancer treatment called…