NEW YORK (Reuters)–The number of Americans who signed up for 2019 insurance plans created by the Affordable Care Act, often called Obamacare, fell by about 4 percent to 8.5 million people from 2018, the U.S. government said on Wednesday. Enrollment had been running about 10 percent lower but picked up during the past week, reflecting…
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Protect Your Practice: Action Update From the ACR’s Insurance Subcommittee
Both private and academic rheumatology practices face payer challenges that put the health of their patients and their practices at risk. To make sure the rheumatologist perspective is heard by payers, “the ACR’s Insurance Subcommittee (ISC) serves as the interface between payers and our members and ACR colleagues,” explains Sean Fahey, MD, a rheumatologist in…
California Insurance Commissioner Sues AbbVie over Humira
(Reuters)—On Tuesday, Insurance Commissioner Dave Jones filed a complaint on behalf of the State of California against AbbVie Inc., alleging the drugmaker gave illegal kickbacks to healthcare providers to prescribe its blockbuster drug, Humira. The regulator alleged that AbbVie engaged in a far-reaching scheme including cash, meals, drinks, gifts, trips and patient referrals, as well…
Patients Lose When Insurance Company Forces Drug Switch
This past June, a 64-year-old man with a history of psoriatic arthritis and severe arthritis appeared at our clinic for his regular follow-up with concerns about a letter from his insurance company. The letter stated the company wouldn’t pay for the patient’s secukinumab (i.e., Cosentyx) prescription anymore and suggested he take ixekizumab (i.e., Taltz) instead,…
ACR Insurance Subcommittee Responds to Payer Policies
Since the beginning of the year, the ISC has sent eight letters to payers in response to problematic policies. Each letter outlines the ACR’s concerns and requests corrective action…
The Battle with Insurance Companies to Obtain Prescriptions
If you are a news junkie, then you know that a tick-tock is a story that relies heavily on chronology, counting down the events of the day, in order, as inexorably as the ticking clock. These types of timeline stories have become very popular in the fast-paced world of modern politics, in which readers eat…
U.S. to Extend Skimpy Health Insurance Outside of Obamacare
WASHINGTON/NEW YORK (Reuters)—The U.S. government on Tuesday proposed extending the availability of skimpy health insurance plans to millions of Americans in another Trump administration move aimed at undercutting the requirements of the Affordable Care Act, often called Obamacare. The U.S. Department of Health and Human Services issued a proposed rule that such plans, now available…
How to Avoid Insurance Denials for Prescribing a Biologic Without MTX in Concert
The Insurance Subcommittee (ISC) of the ACR’s Committee on Rheumatologic Care (CORC) has recently received a number of reports from members regarding denials for biologics for patients not on methotrexate. To help avoid an often-lengthy appeals process, the ACR/ARHP recommends that members document a patient’s history of methotrexate intolerance or contraindication at every visit. What…
U.S. Governors Urge Trump to Make Health Insurance Payments
WASHINGTON (Reuters)—Democratic and Republican U.S. governors on Wednesday urged the Trump administration, as well as Congress, to continue funding payments to health insurance companies that make Obamacare plans affordable, calling it critical to stabilizing the insurance marketplace. In a statement, governors joined insurers pressuring Republican President Donald Trump to stand down from threats to cut…
Congress Must Shore Up Insurance Markets If Obamacare Repeal Fails
WASHINGTON (Reuters)—U.S. Senate Majority Leader Mitch McConnell (R-Ky.) said on Thursday that Congress must act to shore up private health insurance markets if it fails to repeal Obamacare, comments seen as providing a pathway to a bipartisan deal to fix the health system. Speaking at a luncheon in his home state of Kentucky, McConnell said,…
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