Health Plans Backing Away From Voluntary PA Reforms
Just one year after promising major prior authorization (PA) reforms on a voluntary basis, some health plans appear to be backing away from the commitments to the Trump administration that have been heavily touted by both plans and regulators. Some plans have been resistant to proceed on the pledge to implement certain reforms.
Critics says progress has been slow despite health plan trade group AHIP claiming 6.5 million prior authorizations for patients—equal to an 11% reduction – have been eliminated. Critics also say claims denials are on the rise. The administration threatened regulatory action if plans did not agree to come to the table with reforms. Bills on PA reform appear to be moving in Congress.
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Additional article: https://www.fiercehealthcare.com/payers/insurers-hedge-trump-backed-pledge-improve-denials-process
#healthplans #priorauthorization
https://www.modernhealthcare.com/insurance/mh-prior-authorization-reform-pledge-insurers-pullback/
Smaller PBMs Tout Alternative Strategies To Save Costs
Smaller pharmacy benefits managers are touting a number of alternative strategies to win over employer groups and save dollars. Novel strategies include drug importation and alternative funding strategies and models. Uptake is still minimal but growing.
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#pbms #drugpricing #employergroups
https://www.modernhealthcare.com/insurance/mh-pbm-employers-drug-costs
— Marc S. Ryan
