Cost-Containment

"Understanding the financial challenges LGBTQ+ adults face when accessing health care can help identify persistent gaps in affordability and inform efforts to improve access to needed care and coverage," according to a new KFF report.

Patients deserve an individualized coverage determination based on the facts of their case — not assumptions.

A Milwaukee hospital alleges CVS used its control of a PBM, specialty pharmacy and third-party administrator to reduce reimbursements and retain savings intended to support patient care.

Craig Culbertson said one thing a reference-based price plan needs is providers willing to take the reference prices.

Carl Schmid said the working group should start by creating standardized ways to measure prior authorization activity.

Nearly 70% of the estimate rests on payments above an insurer-calculated benchmark that a federal appeals court recently found could be artificially low.