November 6, 2023

The Healthcare Labyrinth Newsfeed Debut

Welcome to The Healthcare Labyrinth Newsfeed! Each weekday, I will review about two dozen healthcare websites for the most relevant information in the world of healthcare generally as well as managed care and health insurance specifically.

You can access the daily newsfeed in a few ways.

1 — Save this link in your favorites and visit each day

2 — If on LinkedIn, click on my daily post about the newsfeed and you will be redirected here.

3 — In the future, we will launch an email subscription (free) and we will email you each day on the newsfeed and other website activities.

Here is the rollout of the new Healthcare Labyrinth website:

November 6 — Newsfeed Debut

November 13 — Blog Debut

November 27 — Podcast Debut

I hope you enjoy the website and newsfeed.

Take care,


CMS Is Strengthening Hospital Price Transparency

CMS is strengthening hospital price transparency regulations by requiring hospitals to make standard charges publicly available in a more standardized manner. While the regulation has already shined a light on major differences in prices regionally and even among insurers in the same region, the additional changes will foster easier insights for academics and researchers and ultimately the public’s understanding.

#pricetransparency #hospitals #healthcarereform

Link to Article

Medicare Drug Pricing Controversy And Dueling Studies Continue

This Health Affairs Forefront blog is authored by staff of a pharmaceutical- and biotech-backed entity. So you need to take what is stated with a grain of salt. Other studies seem to indicate that impacts on research and innovation of drugs will not be substantial. I would argue that if there is some impact on drug introduction, there are ways to overcome this and that high drug prices actually contribute to much suffering and loss because it often bars people from drugs they need to remain healthy — contrary to what the drug makers say. Further, the drug lobby seems to argue that somehow the U.S. should bear the lion’s share of the the world’s drug innovation. How could it be otherwise if drug prices are materially lower in almost all developed countries. Whether voluntary or not, drug makers are part of those developed countries’ systems. (Note: Article may require subscription)

#drugpricing #medicare #medicareadvantage #healthcarereform

Link to Article

AI In Health Plan Authorization Decision-making In Spotlight

After some notable articles on the use of AI-driven claims review, House Democrats are calling on CMS to increase oversight of Medicare Advantage plans’ use of such technology. This comes after a major new rule limit the use of evidence-based criteria.

#medicareadvantage #priorauthorization #medicare

Link to Article

Cigna Could Sell Its Medicare LOB

Surprising news that Cigna could be considering selling its Medicare LOB. In Medicare Advantage it has about 600,000 lives. It has about 2.6 million lives (both Cigna and PBM subsidiary ESI) in standalone PDP. Stay tuned for more. Link to another article as well ( https://www.modernhealthcare.com/finance/cigna-medicare-advantage-business-sale )

#medicareadvantage #cigna #pdp #partd

Link to Article

New Medicare Advantage Rule Covering Numerous Areas

A new 2025 draft rule issued Monday by CMS would mean Medicare Advantage insurers face new limits on marketing, prior authorizations, and supplemental benefits, as well as changes in network adequacy standards around behavioral health. The rule also promotes the use of biosimilar medications. Also see the CMS Press Release here ( https://www.cms.gov/newsroom/press-releases/biden-harris-administration-proposes-protect-people-medicare-advantage-and-prescription-drug ) as well as the CMS Fact Sheet ( https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-policy-and-technical-changes-medicare-advantage-plan-program-medicare ). I will report more on this tomorrow.

#medicareadvantage #medicare #partd #pdp

Link to Article

The Future of Digital Health and AI Investments

With the demise of Olive Health, a good article on the future of digital health and AI investments. Prepare for a rocky road. Some believe the days of “free money” are gone and there will be more of a focus on profitability for investors.

#digitalhealth #ai

Link to Article

Senate Looking At Strengthening Biosimilar Access

Failure of the first biosimilar alternative to the high-cost drug Humira (adalimumab) to capture meaningful market share has the Senate Finance Committee looking to change the paradigm on biosimilars. Brand drug makers use rebates to PBMs and health plans to keep preferred placement on formularies. But these rebates are retrospective in nature and patients do not access lower prices at the point of sale. Biosimilars would be cheaper on a net basis at the point of sale and reduce out-of-pocket costs for consumers. (Note: Article may require subscription)

#durgpricing #biosimilars

Link to Article

Health Plans Give Fair Access To Drugs For Serious Diseases

As health plans are being stung by prior authorization limitations, a new analysis says most of the formularies run by some of the largest health plans provide “fair access” to 18 treatments for a handful of serious diseases. (Note: Article may require subscription)

#priorauthorization #utilizationmanagement

Link to Article

— Marc S. Ryan

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