Category Archives: Insurance

Ohio Medicaid program demands new payment strategy after journalists explain how PBMs use ‘spread pricing’

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: afagen via Flickr

Over the past six months, journalists for the Columbus Dispatch have written more than 40 articles about the murky world of pharmacy benefit managers (PBMs) in Ohio. This week, they wrote one of the most important stories in this ongoing series, “Ohio firing pharmacy middlemen that cost taxpayers millions.”

In this article, they explained that the Ohio Department of Medicaid was changing the way it pays for prescription drugs by, “giving the boot to all pharmacy middlemen” because the Medicaid program wants to shift away from what’s called the “spread pricing” practice. Continue reading

Series explores how pharmacy contracts obscure drug pricing details from consumers

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

When covering prescription drug pricing, one problem that journalists face is understanding the almost-labyrinthian complexity of the drug supply chain, from manufacturer to consumer.

For one of its first investigations, the young publication Tarbell set out to explain why drug prices are so high. In doing so, Tarbell Editor Randy Barrett describes in great detail the complex world of pharmacy pricing. Continue reading

Prior authorization rules: Yet another way the health insurance system frustrates physicians and patients

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

For patients and physicians, many aspects of the health care and health insurance systems are frustrating and appear to be needlessly complex.

One of the most frustrating processes is prior authorization, the mother-may-I approach health insurers use to ensure that procedures, medications and even certain care processes are appropriate and worthy of coverage. Continue reading

‘Short-term’ plans can now be renewed for years

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Photo: kengo via Flickr

In my most recent post, I recapped what Georgetown University’s Sabrina Corlette, who is also a former Senate health policy aide, told us on an AHCJ webcast about association health plans. This post looks at the second part of the webinar, about short term limited duration plans. Both are options expanded by the Trump administration that may undermine the ACA markets. You can see her slides and listen to the webcast here.

It is worth nothing that health insurance remains very expensive for people who are trying to buy coverage on the individual market who do not quality for income-related subsidies in the ACA exchanges. Continue reading

Understanding the new rules for Association Health Plans

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Health care researcher Sabrina Corlette told us about Short-Term Limited-Duration Plans and Association Health Plans – two options allowed by the Trump administration that may undermine the ACA markets – during a webcast in July. You can see her slides and listen to the webcast here.

Corlette, a research professor at Georgetown’s Center on Health Insurance Reforms (CHIR) and a former Senate health policy aide, (more on her background here) covered a lot of ground – and a related CMS rule was posted soon after her talk. So we’ve broken this up into two blog posts, this one about Association Health Plans, or AHPS, and the next on Short-Term Limited-Duration Plans. Continue reading