Unbiased Analysis of Today's Healthcare Issues
That is the question asked in a new paper by Enright, et al. (2025). The authors use the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database current as of August 2023. This database contains publicly available specialty pharmacy coverage decisions as issued by 18 large US commercial health plans, which—collectively—cover 200m people (i.e.,…
This is a question I can’t answer with certainty. Patients often believe that since I’m part of the health-care system, I would know. But I don’t, not as a doctor — and not even when I’m a patient myself. In the United States, health insurance is so extraordinarily complicated, with different insurers offering different plans,…
It looks like the answer is ‘yes’. KFF reports that Holden Karau, a software engineer from the San Francisco Bay Area, created an AI tool to help appeal insurance denials. She calls it: Fight Health Insurance, How does it work? You’ve gotta make a scan of the denial letter from your insurance company, and run…
In the U.S., health insurance premiums are tax deductible–if paid through out of pocket expenses–but out-of-pocket expenses are not. However, there are exceptions to this rule. These include two often-used tax-favored accounts: Flexible savings accounts (FSA). These accounts allow employees to set aside a portion of their pretax income to cover qualified medical expenses; however,…
From the FTC’s press release out today: Today, the Federal Trade Commission brought action against the three largest prescription drug benefit managers (PBMs)—Caremark Rx, Express Scripts (ESI), and OptumRx—and their affiliated group purchasing organizations (GPOs) for engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs, impaired patients’…
Managing multiple medications is a challenge for many individuals, particularly the elderly. One study by Almodóvar et al. (2019) found that among Medicare beneficiaries eligible for medication therapy management (MTM), 51% had used 11 or more medications. One approach to improving medication management is to use an appointment-based model (ABM) and other forms of medication…
Perhaps not. At least that is according to a paper by Anderson et al. (2024). The authors use a difference-in-difference approach with 2018-2021 claims data. A summary of the results are below. Approximately one-quarter of patients who use insulin report underuse because of cost. In response, more than twenty states have implemented monthly caps on…
If you go to the doctor or dentist in the US, you often can get a discount if you pay out of pocket as compared to paying through insurance. Why is that the case? Wouldn’t the physician like to get a big insurance company to pay them as compared to potentially incurring credit card fees…
Patients hate narrow networks. Anything that limits their choice of physicians or hospitals is disliked. Americans love more choice. Payers, on the other hand, like narrow networks because they save cost–through the ability to negotiate lower rates–and potentially increase quality–if the contracted network has higher quality physicians. In fact, according to the KFF Employer Health…
The Congressional Budget Office (CBO) recently released projections of US health insurance levels between 2024 and 2034. In the Hale et al. (2024) study, CBO estimates that: …92.3 percent of the US population, or 316 million people, have coverage in 2024, and 7.7 percent, or 26 million, are uninsured. The uninsured share of the population…