PCSK9 Inhibitors: North Carolina
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in North Carolina from January 2017 through December 2017. Of health plans that received at least 100 claims for PCSK9 inhibitors, the following had the highest rates of rejections: • Express Scripts – 58% • Tricare Military Health SVS SYC – 55% • […]
PCSK9 Inhibitors: New York
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in New York from January 2017 through December 2017. Of health plans that received at least 350 claims for PCSK9 inhibitors, the following had the highest rates of rejections: • Fidelis Care NY – 43% • United Health Group – 34% • Express […]
PCSK9 Inhibitors: New Jersey
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in New Jersey from January 2017 through December 2017. Of health plans that received at least 200 claims for PCSK9 inhibitors, the following had the highest rates of rejections: • Horizon BCBS NJ – 62% • Express Scripts – 41% • United Health […]
PCSK9 Inhibitors: Mississippi
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in Mississippi from January 2017 through December 2017. Of health plans that received at least 50 claims for PCSK9 inhibitors, the following had the highest rates of rejections: • BCBS Mississippi – 97% • State of Mississippi Employees – 94% • Express Scripts […]
PCSK9 Inhibitors: Indiana
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in Indiana from January 2017 through December 2017. Of health plans that received at least 150 claims for PCSK9 inhibitors, the following had the highest rates of rejections: • Anthem – 58% • Express Scripts – 42% • MDwise – 37% • CVS […]
PCSK9 Inhibitors: Illinois
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in Illinois from January 2017 through December 2017. Of health plans that received at least 150 claims for PCSK9 inhibitors, the following had the highest rates of rejections: • Express Scripts – 40% • CVS Health – 31% • United Health Group – […]
PCSK9 Inhibitors: Georgia
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in Georgia from January 2017 through December 2017. Of health plans that received at least 200 claims for PCSK9 inhibitors, the following had the highest rates of rejections: • Anthem – 80% • Georgia State Health Benefit Plan – 54% • Tricare Military […]
PCSK9 Inhibitors: Arkansas
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in Arkansas from January 2017 through December 2017. Of health plans that received at least 50 claims for PCSK9 inhibitors, the following had the highest rates of rejections: • Arkansas State Employees – 95% • BCBS AR – 60% • Express Scripts – […]
Making Treatment Less Rare for Rare Disease Patients
Waiting is a fact of life for patients with rare diseases such as cystic fibrosis.
Many of these men and women, whose disease causes wheezing and frequent lung infections, live waiting for new and effective medications. They have to delay activities due to symptoms that make breathing a struggle. They wait for treatment, fighting through health plan barriers such as prior authorization or awaiting the decision of opaque bureaucracies such as Medicaid pharmacy and therapeutics committees.
Should Medicaid Patients be Required to Work?
Patients covered by Medicaid in Kentucky and Indiana could soon find themselves in a difficult position. According to new rules, recipients must complete 80 hours of “community engagement” or risk losing their health coverage.
