Lawrence Wilson

By adding diagnoses to a patient’s risk analysis that no doctor had ever indicated, an insurance company can gain additional federal payments.

Proposed payment rules for 2027 will prioritize accountable care organizations, rewarding physicians for maintaining patient wellness.

A handful of large corporations now control medication availability, pricing, and payment for the vast majority of Americans.

A new proposed rule would cut Medicare reimbursement by 40 percent on prescription drugs for providers who already get large discounts.

The findings are based on a study of early rate requests by Obamacare insurers in 16 states.

Lawmakers have urged Robert F. Kennedy Jr. to end the dispute between Eli Lilly and major hospital systems over prescription drug discounts and rebates.

The new budget provision levies a fee on companies with 50 or more full-timers receiving Medicaid benefits.

Florida tightens pharmacy benefit managers rules. Iowa bars insurer interference in physician referrals and restricts insurer pre-approval denials.

Enrollment peaked at 22.1 million last year and dropped to 19.2 million as of February, according to federal data released June 26.

Americans should never have to wonder whether a procedure was done out of medical necessity or for profit, officials say.