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STAT+: Carbon Health blasts a major insurer in rare public dispute over coverage

STAT

— Primary care startup Carbon Health blasted health insurer Elevance on Monday for paying it less than competitors and for also refusing to process out-of-network claims — a rare public escalation of the behind-the-scenes disputes between providers and payers. OAKLAND, Calif.

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‘Stunning’ change to United’s colonoscopy coverage roils physicians and patients

STAT

When gastroenterologists learned in March that UnitedHealthcare plans to barricade many colonoscopies behind a controversial and complicated process known as prior authorization, their emotions cycled rapidly between fear, shock, and outrage.

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Navigating Pharmacy Insurance Coverage: How to Evaluate Insurance Plans for Your Business

Digital Pharmacist

One effective way to mitigate these risks is by having comprehensive insurance coverage. Determining the coverage needs and evaluating insurance requirements for your pharmacy can ensure you’re adequately protected in the face of any unforeseen circumstances.

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CMS proposes new pathway for reimbursing breakthrough devices

STAT

Medical device makers may soon have an easier path to securing health insurance reimbursement for their products, following the notice Thursday of a long-awaited rule by the Centers for Medicare and Medicaid Services. The TCET rule is an attempt to make that process more clear.    Read the rest…

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Navigating Health Insurance Coverage for Innovative and Specialty Drugs: Q&A With Maria Kirsch, President of Patients Services at EVERSANA

PharmExec

Kirsch discusses the complexity of the drugs and the verification process, along with EVERSANA’s new platform, ACTICS eAccess.

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Health insurer Excellus will not fund Alzheimer’s drug Aduhelm

pharmaphorum

Health insurer Excellus BlueCross BlueShield has said it will not cover treatment with Biogen and Eisai’s new Alzheimer’s disease drug Aduhelm because it has not been shown to be medically effective. The post Health insurer Excellus will not fund Alzheimer’s drug Aduhelm appeared first on.

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Overcoming Cost Barriers in Specialty Medication

assurecare

In the realm of Specialty Pharmacy , achieving coverage for these prescriptions by insurance after the first attempt is a rarity. Achieving coverage at a cost manageable for the average patient requires a collaborative effort from pharmacists, pharmacy technicians, nurses, patient care coordinators, and other support staff.