Medicare Advantage could become the default health-insurance program for all older adults.
A recent proposal in Congress would automatically enroll older adults in a Medicare Advantage plan and then lock them into that plan for three years — unless they actively opt for traditional Medicare coverage.
Humana said on Tuesday it would eliminate about one-third of prior authorizations for outpatient services by next year, the latest insurer to address the tedious paperwork process that has been a pain point for patients and providers.
The company will remove the authorization requirement for diagnostic services across colonoscopies and transthoracic echocardiograms and select CT scans and MRIs by January 1, 2026.
In its latest report, the CDC said the number of cases is now growing or likely growing in at least 26 states and Washington, D.C. COVID-related emergency room visits for young kids are also the highest they've been since March, according to the data.
For decades, the prices Medicare pays doctors for different medical services have been largely decided not by Medicare itself, but by a powerful industry group, the American Medical Association.
An A.M.A. committee meets in secret to determine the difficulty and time demands of each type of medical visit, test and procedure, and then recommends to Medicare how much doctors should be paid for performing them. And for decades, critics have complained that this process unfairly rewards surgeons and other specialists, at the expense of primary care physicians and other generalists. Medicare officials have been loath to change it because it has spared them from needing their own staff and budget to make such pricing decisions, along with the unpleasant politics of adjudicating conflicts between competing groups of physicians.
But a change buried inside a 1,803-page proposed regulation published last Monday suggests the Trump administration would like to move away from this longstanding system. If finalized, it could begin overturning a process that has entrenched pay advantages for certain kinds of doctors. "We're modernizing Medicare by correcting outdated assumptions in how physician services are valued," said Chris Klomp, a deputy administrator of CMS, in an email.
A lawsuit filed in federal court on behalf of the University of Pennsylvania and its health system alleges that 20 years of skyrocketing prices on drugs that treat diabetes, like insulin, can be blamed on price-fixing by the top U.S. drugmakers and Pharmacy Benefit Managers. The pharmaceutical companies named as defendants in the lawsuit, filed July 11, are Eli Lilly, Novo Nordisk and Sanofi. They are accused in court papers of colluding with pharmacy benefit managers, or PBMs, including CVS Caremark, Express Scripts and OptumRX, to inflate prices over the years.