RSV: National Report Card
A national data supplier provided palivizumab claims for Medicaid and commercial health plans across the nation from January 2019 through December 2019. Health plans deny 40% of palivizumab prescriptions for premature infants born between 29 and 36 weeks gestation. One in every four prescriptions is denied for infants who should qualify for coverage under standard […]
PCSK9 Inhibitors: National Report Card
A national data supplier reviewed PCSK9 inhibitor claims for Medicare, Medicaid, Medicaid managed care, and commercial managed care organizations across the nation from January 2018 through December 2018. Of national health plans that received at least 3,000 claims for PCSK9 inhibitors, the following had the highest rates of rejection: Federal Employee Benefit Plan – 76% […]
PCSK9 Inhibitors: South Carolina
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in South Carolina from January 2017 through December 2017. Of national health plans that received at least 50 claims for PCSK9 inhibitors, the following had the highest rates of rejection: Tricare Military Health Svc Sys – 59% BCBS South Carolina – 54% Express […]
PCSK9 Inhibitors: National
A national data supplier reviewed PCSK9 inhibitor claims for Medicare, Medicaid, Medicaid managed care, and commercial managed care organizations across the nation from January 2017 through December 2017. Of national health plans that received at least 2,000 claims for PCSK9 inhibitors, the following had the highest rates of rejection: • Federal Employee Benefit Plan – […]
PCSK9 Inhibitors: Alabama
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in Alabama 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: • BCBS Alabama – 48% • CVS Health – 45% • Express Scripts – 37% […]
PCSK9 Inhibitors: California
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in California from January 2017 through December 2017. Of health plans that received at least 400 claims for PCSK9 inhibitors, the following had the highest rates of rejections: • BS of CA – 60% • Express Scripts – 48% • Centene – 46% […]
PCSK9 Inhibitors: Florida
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in Florida from January 2017 through December 2017. Of health plans that received at least 300 claims for PCSK9 inhibitors, the following had the highest rates of rejections: • Federal Employee Benefit Plan – 84% • Florida Blue – 51% • Tricare Military […]
PCSK9 Inhibitors: Texas
A national data supplier reviewed PCSK9 inhibitor claims for managed care organizations in Texas from January 2017 through December 2017. Of health plans that received at least 400 claims for PCSK9 inhibitors, the following had the highest rates of rejections: • Federal Employee Benefit Plan – 82% • Tricare Military Health SVC SYS – 44% […]
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 […]
