Core and Group Health

The plan to eventually phase out rebates more broadly portends a seismic shift in the flow of billions of dollars among drugmakers, insurers and employers.

OptumRx has used automated systems to try to encourage patients to follow their doctors' health advice, in an effort to reduce the impact of patients' ineffective use of prescribed medications.

The Elevance unit's commercial plans may deduct the penalty from their allowed amounts for claims that involve the use of out-of-network providers.

The author looks at why plan reimbursement rates for out-of-network are so low.

Employers are demanding more actionable data. Regulators are tightening expectations. Members are overwhelmed by confusing cost information they still can’t use in the moments that matter most.

Burnout, poor working conditions and inadequate wages frequently are cited as key drivers of these shortages.