Posts Tagged: insurers

Opinion

Insurers need transparency, standardization in step therapy

An illustration of an array of prescription medications. (Photo: Adul10, via Shutterstock)

OPINION: Due to cost-cutting policies, health insurers often become a barrier to access for medicines that providers prescribe to patients. One such practice is referred to as step therapy. Step therapy forces patients to try several medications before approving the medication originally prescribed by the doctor.

Opinion

Eliminate the guessing game in step therapy

A doctor writes out a drug prescription for a patient. (Photo: Lisa-S, via Shutterstock)

OPINION: Step therapy forces patients to try insurer-preferred medications before approving the medication initially prescribed by the doctor. Utilized by both public and private insurers, step therapy undermines the clinical judgment of doctors and puts patients’ health at risk.

News

Lawmakers send historic mental-health bills to Newsom

The state Capitol in Sacramento, the seat of California government. (Photo: Always Wanderlust, via Shutterstock)

Landmark legislation to improve California’s notoriously fractured mental-health system has been passed and sent to the governor in the waning days of a chaotic legislative session disrupted by the COVID pandemic. “This package of legislation is a game-changer,” said Maggie Merritt, executive director of the Steinberg Institute.

Opinion

Step therapy: Harmful delays and the patient may suffer

Hospital medical staff checking a patient's records. (Photo: Stokkete, via Shutterstock)

OPINION: It’s never a good idea when insurers cut costs by interfering in the decision-making process between patients and their doctor. But during a national pandemic, it’s a particularly bad idea. I am thinking specifically of an insurance strategy called step therapy.

Recent News

Dialysis dispute targets billing, health

A patient receiving blood dialysis treatment. (Photo: Khajornkiat Limsagul, via Shutterstock)

The Madera patient says he likes his Kaiser doctor and has no desire to switch to publicly funded Medicare, even though he qualifies. But if Senate Bill 1156 is approved, Adames likely wouldn’t get that choice. The bill would require that patients like him receiving third-party assistance would either need to enroll in Medicare or Medi-Cal (for those who are low income), or if they choose to stay on private insurance, they will only receive reimbursement at Medicare or Medi-Cal’s much lower rates.

Opinion

Cancer: Hold insurers accountable for denying patients care

Photo illustration of medical equipment. (Image: ESB Professional, via Shutterstock)

OPINION: My insurance company has entirely ignored my doctors’ medical expertise and flatly refused to pay for the physician-prescribed treatment. I’ve learned that my plight is not unique, that there is a systematic failure to hold insurers accountable for unfair delays and inappropriate denials of recommended cancer care. California’s insurance commissioner, Dave Jones, can fix this.

Opinion

The fight against chronic disease

A man's body seen from behind with dermatitis on the neck. (Photo: Naeblys, via Shutterstock)

OPINION: For the millions of Californians living with chronic health conditions like heart disease, cancer, diabetes, asthma and arthritis, securing adequate and affordable health care coverage can be a challenging feat.

Opinion

Lower drug costs: The PBM role

A photo illustration of prescription drugs. (Photo: txking, via Shutterstock)

OPINION: The public debate around the cost of prescription drugs has unfairly turned on the one player in the system reducing drug costs – pharmacy benefit managers or PBMs.

News

Election 2014: Voter apathy, money in strange mix

Voters may be apathetic on Election Day, but there are some people in California who are excited indeed about the ballot – those who have a big pocketbook interest in the outcome. Campaign spending on six ballot propositions has approached a quarter-billion dollars – a hefty price tag, even in California

News

Audit ordered for low-income health program

A sign advertising a Los Angeles medical clinic. (Photo: JDS via Shutterstock)

A state legislative committee has ordered an audit of provider directories that are given to people in California’s low-income health program, after reports of major inaccuracies. The audit will examine the managed-care directories, whether they list enough doctors who are accepting new patients and whether state regulators have done their jobs overseeing that aspect of the Medi-Cal program.

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