overpayments

Hollywood supposedly is addicted to them. More and more Americans are now trying GLP-1s for weight loss. What is happening here with GLP-1s is something repeated often in the drug world. First, what is a GLP-1? The drugs were introduced in the U.S. beginning in the mid-2000s and have been used for those with type 2 diabetes who were overweight. These are a class of drugs that perform much like a hormone called glucagon-like peptide 1. As blood sugars rise in the blood stream, the drugs stimulate the production of more insulin, which lowers blood sugar levels. This is essential for controlling type 2 diabetes. It’s not clear how the GLP-1 drugs lead to weight loss overall, although the drugs do appear to slow the movement of food through the digestive tract and make you feel fuller. How did it become popular for weight loss? Now let’s get into off-label use of

Since the No Surprises Act (NSA) was passed in late 2020, I have argued that the baseball-style arbitration process is heavily stacked against health plans and favors providers.  The law went into effect on January 1, 2022, with some portions still forestalled by the federal government.  But the main components  that stop surprise billing to patients and the process to settle what is paid by plans to providers has been in force now for about 2 years.  The implementation of the arbitration has been rocky.  The number of cases is demonstrably above what was expected.  That said, more and more data is now available that shows how well providers are doing from the process. In commercial coverage, the main component of the law disallows providers from billing patients for out-of-network services beyond plan outlined in-network cost-sharing for emergency situations, post-emergency stabilization, and non-emergency in-network facility-based procedures where non-network services may

Mark Cuban is known as a bold entrepreneur — a smart-thinking guy who cuts through all the nonsense to come up with the right solution. But how audacious was he at a recent White House forum when he suggested that federal and state programs as well as employers essentially cut the top three pharmacy benefits managers (PBMs) out of the pharmacy spending equation altogether in favor of a transparent model? However difficult in the short term, I believe the provocative Cuban has the right answer and wants to aggressively go after it. The entrepreneur is a recent entrant into the world of healthcare. His Cost Plus Drug Company (CPD or Cost Plus) is taking the nation by storm by showing how going direct to the manufacturer — and then to the consumer — can make money and lower costs. He would argue it is not a new model in free