KHN

Pharmacy benefit managers have curtailed in-person audits of pharmacy claims during the pandemic, switching to virtual audits done by computer. That has markedly increased the number of claims they can review — and the chances for payment denials — squeezing pharmacies and bringing in more cash for the benefit companies.

The latest research shows that although deaths in nursing homes received enormous attention, far more older adults who perished from covid lived outside of institutions. People with dementia and other severe neurological conditions, chronic kidney disease and immune deficiencies were hit especially hard.

State health officials say the federal government will likely reject any work or community engagement requirements, which were key to Republican lawmakers agreeing to extend the program that insures 100,000 low-income Montana adults.

Providence, the country’s 10th-biggest hospital chain, says it’s too expensive to upgrade an older hospital, so it will join forces with giant Kaiser Permanente to build a new one.

Health insurers could do more to encourage vaccination, including letting the unvaccinated foot their bills.

The success in getting shots to older adults is likely due to states prioritizing that effort when the vaccines became available and motivation among the elderly after the virus killed so many in their age group.

The Medicare rule, designed by the Trump administration to take money away from drug industry brokers and provide refunds to patients, has not been implemented. But budget analysts say if it were, it would cost the government money. So senators are pushing the rule aside and claiming to save billions of dollars, which they want to use instead on new projects.

Community Health Systems, a large, for profit hospital chain, shrank from more than 200 to 84 facilities. It is continuing to sue patients for hospitals that now exist as little more than legal entities.

The Supreme Court, come autumn, will consider a Mississippi law that bans nearly all abortions after 15 weeks of pregnancy. That’s hardly the most restrictive abortion law passed in the South. How did anti-abortion views become concentrated in the South?

The pandemic forced new parents to find help with breastfeeding online. Now, some offerings are remaining virtual to help expand access to lactation support.

Restrictive abortion regulations enacted across the South require women to drive across state lines to find safe services. With the U.S. Supreme Court set to hear a challenge to Roe v. Wade, abortion rights defenders say long drives and wait times could become the norm across much of America.

Big Bend Regional Medical Center, the only hospital in a sparsely populated region of West Texas, announced that because of a nursing shortage its labor and delivery unit must close for days at a time and patients must go instead to a hospital an hour away.

The Biden administration is weighing how to treat urgent care clinics as part of broad regulations banning surprise, out-of-network medical bills. At the heart of the matter: What counts as an emergency?

Relationships with people you know only superficially can help develop a sense of belonging and provide motivation to engage in activities. Research has found that older adults who have a broad array of “weak” as well as “close” ties enjoy better physical and psychological well-being and live longer than people with less diverse social networks.

Health plans’ coverage of the medication, branded as Wegovy — which has a $1,300-a-month price tag — is not a sure thing.

California Gov. Gavin Newsom faces a recall election in September, fueled in part by anger over his pandemic policies. The health care industry has ponied up more than $4.8 million so far to defend the first-term Democrat.

Using detailed maps that show vaccination rates down to the ZIP code or census tract level, health departments highlight areas of greater Denver where vaccinations lag behind state or county averages, then partner with community organizations to overcome barriers. Can this be a model for President Joe Biden’s “neighborhood by neighborhood” approach?