United Limiting PAs
UnitedHeathcare said it would eliminate prior authorization (PA) requirements for 30% of services that previously required payer approval. It plans to roll out the changes by the end of the year. Services seeing removal of PA will be outpatient surgeries, diagnostic tests, and chiropractic care.
I will have a blog on Thursday on ongoing PA reforms.
In other news, the California Hospital Association sued to stop Elevance Health from implementing a policy that would cut payments to hospitals that refer some members to out-of-network providers.
Additional articles: https://www.fiercehealthcare.com/payers/unitedhealthcare-reduce-prior-auth-requirements-30 and https://www.modernhealthcare.com/insurance/mh-unitedhealthcare-prior-authorization-cuts/
(Some articles may require a subscription.)
#unitedhealthcare #elevancehealth #priorauthorization #healthplans
https://www.modernhealthcare.com/insurance/mh-california-elevance-out-of-network-penalty-lawsuit/
Oz’s PA Reform Push
Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz published a blog where he featured prior authorization (PA) limits and urged continued reforms. His blog began: “A common practice imposed by health insurers on patients and providers is their intrepid need to second-guess clinician treatment decisions by requiring prior authorizations before paying a claim. The current prior authorization process creates unnecessary delays for patients, burdens health care providers with excessive paperwork, and erodes trust between payers and health care providers, even though all share the same goal: delivering high-quality patient care.”
I will have a blog on Thursday on ongoing PA reforms.
#priorauthorization #healthplans #cms #oz
https://www.cms.gov/newsroom/blog/moving-prior-authorization-21st-century
CVS To Expand Biosimilars
CVS announced it will expand its use of lower-cost biosimilars and transition to interchangeable alternatives for select brands. CVS will transition from Stelara to the biosimilars Pyzchiva and Yesintek, including members paying $0 out of pocket. It will also expand biosimilar coverage for specialty treatments, including multiple sclerosis and rare blood disorders.
#biosimilars #drugpricing #branddrugmakers
— Marc S. Ryan
