Findings of a survey of large employers indicate that utilization management tools are ineffective in controlling health care costs for employees and may lead to barriers to treatment. Employer ...

California Governor Newsom signed Senate Bill 1120 into law, which is known as the Physicians Make Decisions Act. At a high level, the Act aims to safeguard patient access to treatments by mandating a ...

As healthcare costs continue to rise, businesses face increasing pressure to balance comprehensive benefits with financial sustainability. One of the most significant challenges is the escalating cost ...

Drug utilization management such as prior authorization and stricter formularies cost the healthcare industry $93 billion annually, with patients bearing the largest share of the cost, a new study ...

Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

Federal and state policies, including the executive order Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients (MFN) and the Inflation Reduction Act (IRA), have transformed ...

MADISON, Wis.--(BUSINESS WIRE)--Navitus, the nation’s first and largest transparent, full pass-through pharmacy benefit manager (PBM), announced today it has achieved a series of accreditations and ...

"It is critical that hospital-based utilization management programs embrace AI and language processing technology to stay current with the industry," said Ms. Soroosh. "We can no longer throw FTEs at ...