Indianapolis-based Elevance Health, which operates Anthem plans, said that in most cases, it won’t cover Ozempic unless a patient is diagnosed with diabetes and has tried another medication to manage it, but physicians can still prescribe it.
The two companies said the combination builds on a seven-year collaboration in Louisiana through joint ownership of Healthy Blue, which serves Medicaid and Medicare Dual Eligible members.
The proposals aim to lower prescription drug costs, promote competition among physicians and end the practice that allows for inaccurate medical billing in certain circumstances.
The longtime industry standard of negotiating hospital reimbursement as a discount on the hospital’s billed charges is being replaced with fixed rates based on what Medicare would pay for a given service.
The federal No Surprises Act—which took effect Jan. 1 and protects patients from receiving surprise medical bills resulting from unexpected, out-of-network coverage—is already creating huge waves.
Of all the industries in the country, health care might be the juiciest for cyberhackers. And around central Indiana, institutions large and small are paying the price.
A series of federal and state actions are putting the $400 billion PBM industry under a spotlight.
Indianapolis-based health insurer Anthem Inc. is suing a former executive, claiming he stole trade secrets, went to work for a direct competitor, and breached a contract involving restricted stock agreements.
The Indianapolis-based health insurer said the name change will better reflect its mission of “elevating whole health and advancing health beyond healthcare.”
Starting in early spring, up to eight free tests will be available each month to people who have Medicare’s “Part B” outpatient benefit, which about 9 in 10 enrollees sign up for.
Two former employees of Anthem Inc. claim the Indianapolis-based health insurer set work quotas so high that it was impossible to meet them in a 40-hour week, forcing them to work unpaid overtime. Anthem declined to comment.
Over the past decade, premiums for family coverage under employer-sponsored health insurance has climbed 47%, faster than wages (31%) or inflation (19%), according to the Kaiser Family Foundation Employer Health Benefits Survey.
In Indiana last year, dozens of insurers across the state rolled out plans hoping to get a sizable piece of the fast-growing market.
The Indianapolis-based insurer, which left the program in 2018 after racking up huge losses, is jumping back in under a partnership with three hospital systems covering 45 of Indiana’s 92 counties.
A new report submitted to the Indiana Legislative Council calls for the regulation of “white bagging,” a practice that requires hospitals to buy drugs from an outside pharmacy, which delivers them premixed ahead of time of the patient’s visit. It is a growing practice, aimed at lowering the cost of care, but many providers say it can compromise care.
The group, Hoosiers for Affordable Healthcare, is pushing an amendment that would require most of Indiana’s hospitals to hold annual public meetings to explain their prices, including any price increases, and to take questions about their finances.
Health care practitioners and insurers are fighting over the hefty prices hospitals charge for specialty drugs to treat patients with cancer, vision loss, low white-blood-cell count and other serious diseases.
Three bills advancing through the Indiana General Assembly would provide tighter regulation of pharmacy benefits managers (PBMs).
The benefits administrator, DirectPath LLC, offers a variety of technology-driven services for employees and employers.
Paying a half-billion-dollar settlement might seem painful, but health care observers say resulting changes to Blue Cross Blue Shield rules are so favorable to Anthem’s growth prospects that the deal is a huge win.
