In 1965, Title XIX of the Social Security Act established the Medicaid program to provide health care coverage to low-income individuals. Over time it has developed into one of the nation's largest payers for health care, covering one out of

Recent reports from the HHS OIG and the Louisiana Auditor General have indicated a high rate of Medicaid improper payments due to incorrectly determining Medicaid eligibility. The Senate Finance Committee wrote CMS on March 1st to inform the agency of

Legislation such as the Improper Payments Information Act (IPIA P.L. 107-300) and Executive Order 13520 sought to address improper payments in government-funded programs. IPIA directed federal agencies to report on the number of improper payments occurring and outline what actions

2019 has been a busy year for healthcare legislation in Texas and one bill, in particular, aimed to carve out PBM’s entirely. House Representative J.D. Sheffield (R) introduced HB 3388 on March 6th in an attempt to reform the delivery

At the beginning of the year, California’s governor signed an executive order directing DHCS to adopt a fee-for-service model for Medi-Cal. Under the order, California would consolidate its purchasing power and leverage the state’s population size to achieve lower drug

Since state Medicaid programs are responsible for the healthcare of several populations, skyrocketing prescription drug costs have become a major budgetary concern. Currently, health care spending is dominating many of their budgets and on a per capita basis, inflation-adjusted retail

Medicaid has been designated a high-risk program by the GAO since 2003 due to its size, growth, diversity and oversight challenges regarding improper payments, appropriate use of program dollars, and data. In fiscal year 2018, improper payments represented about 9.8%

The Trump administration released its 2020 budget proposal on Monday and it gives some insight into the president’s priorities. The budget includes $1.9 trillion in cost savings for Medicaid and other safety net programs. According to the administration, A Budget

In 2018’s legislative session, 45 laws were passed by 28 states to address the problem of prescription drug costs. Apart from these legislative efforts, administrative actions are also being taken to improve the management of Medicaid pharmacy benefits spending. Ohio,

2018 witnessed a wave of healthcare mega-mergers. One of the most significant acquisitions was between CVS Health and Aetna for $69 billion dollars. The PBM announced its plan to merge with one of the nation’s largest health insurance providers in