WORKWEEK

Once upon a time—way before my time, but perhaps in your time—physicians used to make home visits. If they couldn’t see you in your home, you’d go to their private practice, where you knew the entire staff well, and they knew you. Since that time, medical care has become extraordinarily corporatized. Payers, major retailers, and…

Novo Nordisk’s semaglutide added another win to its books, this time showing significant reductions in symptoms in patients with heart failure with preserved ejection fraction (HFpEF). Are you asking yourself, “Geez, what can’t this drug do?” You’re not alone. In this article, I’ll summarize the latest STEP-HFpEF clinical trial, highlight semaglutide’s history thus far, and tie it…

There’s a lot to love about Medicare Advantage if you’re a beneficiary, plan issuer, or corporation in the MA market. Beneficiaries get some extra benefits like dental coverage while insurers and corporations reap massive revenues from MA payments. Despite its stellar enrollment growth, MA—capturing 51% of the entire Medicare population—is fundamentally broken and costing the…

3 JUNE 2023 Prior Authorization: Insurers’ Delight, Physicians’ Plight, and Patients’ Pain UnitedHealthcare’s last-minute reversal from implementing a new prior authorization rule for non-screening endoscopies has stirred controversy. Initially backed by evidence of procedure overutilization, the rule faced staunch opposition from gastroenterologists concerned about potential patient harm and added physician stress. Delve into the intricate…

CMS announced the 10 Medicare Part D medications slated for pricing negotiations next year, on which Medicare enrollees spent a staggering $3.4 billion in out-of-pocket expenses in 2022. CMS has not been able to negotiate drug prices as other countries do, thanks to the Medicare Modernization Act of 2003. Now, the recently signed Inflation Reduction Act (2022) allows…