Health plans’ coverage of the medication, branded as Wegovy — which has a $1,300-a-month price tag — is not a sure thing.
The summer that promised to let Americans resume a relatively normal life is turning into another summer of anxiety and face masks, as the delta variant drives covid caseloads up in all 50 states. Meanwhile, the Americans with Disabilities Act turns 35, and the Missouri Supreme Court orders the state to expand Medicaid after all. Mary Ellen McIntire of CQ Roll Call, Anna Edney of Bloomberg News and Rachana Pradhan of KHN join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews KHN’s Samantha Young, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about an Olympic-level athlete with an Olympic-size medical bill.
A bicyclist from California competed in a Pennsylvania race that could have landed him in this month’s Tokyo Olympics. Instead, a crash on the velodrome track landed him in two hospitals where his out-of-state, out-of-network surgeries garnered huge bills.
Pharmaceutical companies routinely cover the cost of patient copays for expensive drugs under private insurance. A federal judge could make the practice legal for millions on Medicare as well.
The most recent covid relief law offered federal funding to pay insurance premiums for workers who lost their jobs and opted to keep their workplace insurance through COBRA. But the window to take advantage of the subsidized coverage is closing: Many workers would need to enroll in the program by July 31.
U.S. Rep. Sharice Davids (D-Kansas) introduced a bill to do away with a health insurance rule that dictates which parent’s plan becomes a new baby’s primary insurer. This could save some parents from unexpected, sometimes massive medical bills. Davids took up the issue after a KHN/NPR Bill of the Month story on one family’s unexpected $207,455 NICU bill.
In a suburb of Denver, a doctor runs a clinic that finds creative solutions to treat a large refugee and immigrant population, sometimes to the dismay of the medical establishment.
The landmark federal health law required most commercial health plans to cover a comprehensive list of birth control methods approved by the Food and Drug Administration free of charge to female patients. But health plans don’t have to cover every option, and newer methods are not included in the federal list of covered services.
Sen. Ron Wyden (D-Ore.), who is helping to negotiate the health care spending framework for the Democrats’ budget plan, said lawmakers may have to settle for very basic versions of programs deployed in the package. But the key, he added, is to get the “architecture of these changes, bold changes,” started and show people what is possible.
State lawmakers aim to expand Medicaid enrollment by dedicating billions of dollars in coming years to simplifying paperwork, extending pregnancy coverage and opening the program to thousands of new enrollees, including older unauthorized immigrants and people who need nursing home care.