Medicare Advantage plans are frequently lauded for providing high-quality insurance coverage. And they're widely popular among Medicare-eligible consumers. But there's a dark side to these plans as well. In fact, dozens of federal audit reports indicate that Medicare Advantage plans are making the same kind of deficiencies year after year, especially when it comes to inappropriately rejecting claims. The Centers for Medicare & Medicaid Services found that in 61 percent of the audits, insurers turned down claims for prescription drugs when they shouldn't have. This is not something to take lightly. Many seniors take prescription medications, and many of those drugs are vital to their health and medical conditions. To potentially block their access to those drugs could prove extremely detrimental.
Efforts to curb growing rates of prescription painkiller abuse--along with healthcare fraud and wasteful spending riding on their coattails--have made it harder for patients with chronic pain to get the medicines they need.
Drug companies aren't doing enough to stop customers from using co-payment coupons to pay for Medicare Part D prescription drugs, according to a report by the Office of Inspector General.
Pa yers have faced allegations of discriminating against patients with certain health conditions; a violation under the Affordable Care Act. But some insurers are finding ways around the provision by shifting more of the cost of prescriptions onto consumers.
Given the recent surge in pricey prescription drugs, lawmakers are calling for Medicare to offer rebates and negotiate prices to reap significant savings, according to a report released Wednesday by advocacy groups the Medicare Rights Center and Social Security Works.
The challenges of controlling prescirption drug-related fraud are clear as these schemes continue to make news.
Choosing costly prescription drugs over cheaper alternatives drains Medicare of $29 billion per decade, a Health Affairs study found.
The Office of Inspector General issued guidance last week to control fraud and abuse linked with independent charity patient assistance programs (PAP) for federal healthcare program beneficiaries.
Recent studies of the hepatitis C drug Sovaldi are of poor quality and don't answer pertinent questions about the drug's safety, according to a new report from The Center for Evidence-Based Policy at Oregon Health and Science University.
The pharmaceutical industry is concerned that cost-sharing within most health insurance exchange plans could limit consumers' access to necessary medications, says a new report from the Breakaway Health prepared for the Pharmaceutical Research and Manufacturers of America.