There's been a long lull in fighting between primary care and specialty doctors over how much they get paid by Medicare, but that truce might not last if Congress overhauls the system that determines physician payment.
The laws ban so-called step therapy, also known as 'fail first,' which requires patients to use more cost-effective treatments first before allowing a more expensive option even if that is physician-recommended.
In a legal fight involving two health insurance companies seeking to manage North Carolina's public employee benefits plan, a judge ruled Monday that the plan’s board acted properly when it switched to Aetna and dropped longtime administrator BCBS of North Carolina.
The FTC argues the three biggest PBMs - managing 79% of U.S. prescription drug claims - have greatly enriched themselves at the expense of smaller pharmacies and consumers, according to an interim staff report calling for possible greater regulation.
Legislation could help, said Robin Sparks, a Marysville cancer care advocate. Exhausting insurance policies have doctors quitting and patients abandoning care.