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Prior authorization, or preauthorization, [1] is a utilization management process used by some health insurance companies in the United States to determine if they ...
Medicaid beneficiaries in North Carolina will soon be able to get GLP-1 drugs like Wegovy, Saxenda and Zepbound covered. NC Medicaid to cover weight-loss drugs like Wegovy, after access cut for ...
In North Carolina, Medicaid costs are split between the State (34.87%) and the Federal government (65.13%). [13] "Ranking ninth among states in total Medicaid spending, North Carolina's Medicaid program has worked hard not just to cut spending to keep the program solvent, but also to contain costs while improving the quality of health care."
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
Even for doctors trained in addiction medicine — motivated to treat opioid addicts with buprenorphine and able to work within Medicaid’s numerical limits — there are still roadblocks. Kentucky’s Medicaid program, like those of many other states, requires prior authorization before it agrees to pay for the medication.
The average beneficiary in the prior coverage gap would have spent $1,504 in 2011 on prescriptions. Such recipients saved an average $603. The 50 percent discount on brand name drugs provided $581 and the increased Medicare share of generic drug costs provided the balance. Beneficiaries numbered 2 million [17]
Under an HCBS waiver, states can use Medicaid funds to provide a broad array of non-medical services (excluding room and board) not otherwise covered by Medicaid, if those services allow recipients to receive care in community and residential settings as an alternative to institutionalization.
Texas Attorney General Ken Paxton (R) filed a lawsuit Wednesday accusing a second doctor of violating a state law banning gender-affirming care for transgender minors. The lawsuit, filed in a ...