Coverage, quality, and the economics of how care gets paid for.
California’s laws still leave extradition decisions related to reproductive rights and gender-affirming care to its governor. But as states with abortion bans target California physicians who prescribe abortion pills across state lines, Democrats want to lock in protections for doctors, no matter who the next governor is.
Avere Therapeutics has burst onto the scene by securing a public listing via a reverse merger with NextCure, while stocking a pipeline with an IL-23 drug from Hansoh Pharmaceutical.
Republicans say California’s use of Medicaid money for social services amounts to waste, fraud, and abuse. But even as Gov. Gavin Newsom voices concern about losing funding, he says he’s proud of the state’s holistic approach to caring for its sickest and most expensive patients.
CMS’s new GLP-1 Bridge program expands Medicare access to obesity drugs but raises concerns about cost, supply and implementation challenges. The post Does CMS Know What It Is Doing With Its GLP-1 Obesity Coverage Pilot? appeared first on MedCity News .
The honest question is not whether AI will end the fight. It will not. The honest question is what AI does to a fight that has been structurally imbalanced for 30 years. The post Prior Authorization is a Fight and AI Won’t End It — Stop Pretending Otherwise appeared first on MedCity News .
For many of Medicaid’s highest-need members, the problem isn’t that services don’t exist. It’s that the system can’t consistently reach the people who need those services most. The post Medicaid’s Next Performance Test: Can Plans Reach the Members They’re Accountable For? appeared first on MedCity News .
To truly deliver on the promise of proactive, preventive care for seniors with complex, chronic conditions, we should move away from the current one-year open enrollment cycle and toward a five-year contract period. The post Stop the Revolving Door: Why Five-Year Contracts are the Key to Saving Medicare Advantage appeared first on MedCity News .
KFF Health News journalists made the rounds on national and local media recently to discuss topical stories. Here’s a collection of their appearances.
Washington state has launched the first program to help cover home care and other supports. Several other states are paying attention.
New Medicaid work requirements could make a complex system even harder for farmworkers to navigate.
KFF found that ACA Marketplace insurers are proposing a median 14% premium increase for 2027, driven by rising healthcare costs and the expiration of enhanced premium tax credits. The post ACA Marketplace Insurers Propose 14% Median Premium Increase in 2027 appeared first on MedCity News .
Over the past 70 years, the number of inpatient psychiatric beds has dropped dramatically, leaving many without critical care when they experience mental health crises. I was one of the lucky ones to get a bed — after 21 hours of waiting.
This cross-sectional study examines US state-level variation in days at home among older dually eligible Medicare beneficiaries with Alzheimer disease and related dementias (ADRD).
Pearl’s $110 million raise includes a $50 million equity investment led by Andreessen Horowitz with participation from Viking Global Investors, AlleyCorp and Ulysses Capital, as well as a $60 million debt facility led by Trinity Capital. The post Pearl Health Lands $110M to Support Value-Based Care for Medicare Patients appeared first on MedCity News .
Health plans are operating in a complex and rapidly changing environment. As more clinical data streams become available for quality reporting and care management, challenges persist in measuring the quality of these new data sources. NCQA has been exploring ways to improve data quality while reducing reliance on manual data verification, including Primary Source Verification […] The post Help Shape the Roadmap for the Future of Data Validation appeared first on NCQA .
Insurance coverage losses caused by the Trump administration's tax and spend law could make it harder for biotechs to secure funding and recruit patients for trials, experts have told Fierce.
Insurers that sell plans in Obamacare marketplaces across 16 states and the District of Columbia have asked regulators to approve a 14% median premium increase for 2027, according to a new Peterson-KFF analysis.
Many Americans are shopping around for affordable options as the cost of health insurance soars. But some who hope to keep the same doctors and medications face a thicket of red tape and disruption after they switch plans.
Elevance filed a lawsuit last week against the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, alleging that CMS unlawfully refused to recalculate Elevance’s 2026 Medicare Advantage Star Ratings on the same basis that it recently recalculated Clover Health’s ratings after a court ruling. The post Elevance Sues CMS Over Star Ratings, Seeks Same Recalculation Applied to Clover appeared first on MedCity News .
Drugmakers provide financial assistance to help patients afford increasingly expensive medications. But some insurers do not count those payments toward a plan’s deductible or out-of-pocket maximum and make patients pay instead.
Thousands of people who had a Medicare drug plan with zero-dollar premiums last year got small premium increases this year — and didn’t know it. They were dropped from their coverage for failing to pay amounts as little as $8, and most can’t get it again until 2027.
Vertex Pharmaceuticals has struck a $10 billion deal—its largest ever—to acquire endocrine disease specialist Crinetics Pharmaceuticals. The transaction's two focuses, Palsonify and atumelnant, have combined peak sales potential of more than $5 billion, Vertex said.
This economic evaluation estimates the number of and costs associated with Medicare beneficiaries aged 65 years or older receiving care for HIV in the US from 2026 to 2035.
This cross-sectional study characterizes opioid analgesic prescribing trends in the US among commercially insured and Medicare Advantage patients by prescriber specialty, analyzing short-term and long-term opioid use episodes separately.