Susan Morse
Impacted payers need to send prior authorization decisions within 72 hours for urgent requests and seven days for standard requests.
Over 18% of consumers signing up for a plan are new to the marketplace, including some who formerly had Medicaid coverage.
Intermediate sanctions, effective on January 12, are due to low Medicare Advantage star ratings.
Humana brought the case against Walgreens in February 2022, claiming the retailer had inflated prescription drug prices for years.
"We take our members and treat them really, really nicely," says CMO Neil Wagle.
Hospitalizations for COVID-19 have increased 20% since mid-November, according to the CDC.
Two of company's MA plans earned 5 stars in 2024, during a difficult year to rank highly in the Medicare Advantage star ratings.
The disincentive structure proposed is excessive and threatens the financial viability of economically fragile hospitals, AHA says.
The Houston-based health system for children and women is a HIMSS Davies Award of Excellence winner.
Rebates bring down prices by as much as half.