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Medscape (Subscription required)
Medicaid programs in Delaware, Maryland, New Jersey and Pennsylvania denied nearly half of all claims in recent months for direct-acting antiviral hepatitis C drugs, according to an analysis of pharmacy data presented here at the Liver Meeting 2015. Jeff Myers, chief executive officer of Medicaid Health Plans of America, told Medscape Medical News that his association believes such restrictions are "clinically appropriate and medically necessary."
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The Hill
The House Oversight Committee quietly announced it will hold a hearing on controversial drug pricing practices amid intensifying criticism from Democrats. A spokeswoman for Chairman Jason Chaffetz (R-Utah) said in a statement that he plans to hold a hearing "early next year." The hearing will focus on aggressive drug pricing by companies like Turing and Valeant pharmaceuticals, both of which have been accused of price-gouging.
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MHPA
Click on the session names to download select presentations. You may also access them through the online version of the mhpa2015 conference app — just click on the schedule icon for the sessions. The presentations are listed in the documents section.
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The Medical News
UPMC for You, the Medical Assistance program of UPMC Health Plan, was honored by the (MHPA Institute for Medicaid Innovation for demonstrating innovative and effective approaches to providing services that have improved the health of Medicaid enrollees, at MHPA's annual Best Practices Awards program held in Washington, D.C., earlier this month.
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Complex Clinical Reviews. Dependent Audits. And More.
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Courier-Journal
Traveling around rural Clay County, Jennifer Gates seeks out people in need of health coverage. There are plenty of them. From the homeless veteran under a bridge to the low-paid school cafeteria cook, Gates helps them find health coverage through kynect, Kentucky's version of the Affordable Care Act.
Many qualify for Medicaid, the government plan for the poor, even though they have jobs, said Gates, a social worker for Grace Community Health Center in Manchester and a "kynector," helping people connect with health coverage.
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Los Angeles Times
Columnist Michael Hiltzik writes: "Medicaid is the healthcare family's poor relation. It's taken for granted. Its quality is widely derided, even as it's typically saddled with the lowest provider reimbursement rates of any government health program. Republican governors and legislatures refused to accept the central role it was given as the insurance plan for their poorest constituents (though that's been changing).
"So here's a shocker: Children on Medicaid receive very good care — in many respects better than those on private insurance. That's the conclusion of a survey of health data from 2003 to 2012 for 80,655 children, conducted by researchers at the University of Pennsylvania and Johns Hopkins. The children were in families earning between 100 percent and 300 percent of the federal poverty level — between $20,090 and $60,270 for a family of three in 2015."
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AL.com
A task force appointed by Alabama Gov. Robert Bentley recommended that the governor and the legislature find a way to provide health insurance for Alabamians without coverage. The Alabama Health Care Improvement Task Force approved a recommendation that said the biggest obstacle in improving health is the "coverage gap that makes health insurance inaccessible to hundreds of thousands of Alabamians."
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With an emphasis on innovative initiatives and data-driven solutions, DentaQuest is partnering with health plans to fundamentally change the way oral health is delivered in America. Integrating preventive oral health programs not only offers members a wider portfolio of choice - it is also a proven driver of cost control.
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Healthcare Dive
A new study published in the American Journal of Public Health compared 3,000 adults living below the federal poverty level without health insurance and 1,500 adults with Medicaid between 1999 and 2012. Adults with Medicaid were more likely to have at least one doctor visit a year, more aware of their health status, and had better control of their high blood pressure than those without insurance. However, there was no association with awareness or control of diabetes or high cholesterol.
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MHPA
"What If We Knew The Future: A Prevention Approach to Safer Use of Prescription Opioids," an RxAnte webinar presented by Michael Ross, M.D., chief medical officer, and Amie Joyce, MPH, vice president of account management at RxAnte, took place on Nov. 18.
Download the presentation.
MHPA
MHPA and its sister organization, the Institute for Medicaid Innovation, awarded select member companies for innovative best practices that have improved the health of Medicaid enrollees.
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