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On April 10, the Centers for Medicare & Medicaid Services (CMS) announced it is proposing changes to slash long waiting periods for drugs, thereby reducing barriers to timely access to critical treatments. According to a press release, the proposed rule on Interoperability Standards and Prior Authorization for Drugs would advance reforms to modernize prior authorization for drugs by establishing clear decision deadlines for affected payers – no later than 24 hours for urgent requests and 72 hours for standard requests – and by increasing transparency through full disclosure of claims denials and appeals outcomes.
Healthcare spending varies widely between metropolitan areas, according to new data from the Health Care Cost Institute. The research group has unveiled its Health Cost Landscape report (PDF) and tool, which pulls from more than 1.3 billion medical claims submitted from 2018 to 2022. This data reflects 38 million people enrolled in employer-sponsored health coverage.
Analytics and market research firm Trilliant Health has released a report signaling that the behavioral health crisis has intensified in the years following the COVID-19 pandemic, with demand surging 62.6% since 2018. Between 2018 and 2024, behavioral health utilization increased to 1,346 visits per 1,000 people. Anxiety disorders saw the highest utilization and fastest growth during this time (+89.3%), with utilization concentrated among women ages 18-44.
AI regrets? Health systems learn lessons from the early boom
In the early days of the AI boom, health systems often jumped at the chance to try out the latest tool. Many organizations ended up with a surplus of redundant — or ineffective — solutions. But they discovered key insights that they’ve applied to later AI investments, IT leaders told Becker’s.
Bill would force payers to apply DTC drug purchases to patient deductibles
A prominent physician voice in the House of Representatives has introduced a new bill that would compel insurers to apply the cost for drugs purchased from direct-to-consumer platforms to deductibles and out-of-pocket maximums. North Carolina Republican Greg Murphy, M.D., on Tuesday unveiled the Every Dollar Counts Act, a bill that aims to lower patients' out-of-pocket costs for pharmaceuticals.
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