OIG: 3 Largest MA Insurers Deny Prior Auth Requests at High Rates for Long-Term Acute Care, Inpatient Rehab
Marissa Plescia / medcitynews - An OIG report found that the three largest Medicare Advantage insurers denied prior authorization requests for long-term acute care and inpatient rehabilitation at higher rates than other MA plans in 2024.The post OIG: 3 Largest MA Insurers Deny Prior Aut…
AI Summary: A federal watchdog report revealed that the largest Medicare Advantage plans are denying prior‑authorization requests for long‑term acute care and inpatient rehabilitation at notably high rates, prompting scrutiny that the benefit design may be limiting medically necessary care to save costs. Regulators and hospitals are now pressing for explanations and fixes.
UnitedHealth, FTC reach proposed settlement in insulin case
Emily Olsen / healthcaredive - The tentative deal comes months after CVS Health reached a proposed settlement in the lawsuit alleging major pharmacy benefit managers are inflating insulin costs.
AI Summary: UnitedHealth/Optum Rx reached a proposed settlement with the FTC over alleged anti-competitive insulin rebate and pricing practices, including terms to resolve claims that rebates harmed competition and patients. The agreement would curb disputed pharmacy benefit manager conduct and could reshape how insulin discounts are negotiated and passed through to consumers.