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Leslie Small

Latest From Leslie Small

Birth Control Guidance For Insurers Aims To Boost Coverage, Smooth Exemption ‘Pathway’

Three-agency guidance, issued as Biden administration is hoping to emphasize reproductive rights in its reelection campaign, outlines the narrow set of circumstances in which a health plan doesn’t have to fully cover certain types of birth control.

Women's Health Reimbursement

‘D’ Is for Dynamic: CMS Proposals Could Shake Up Medicare Drug Benefits

While many IRA changes are seen as having an adverse effect on stand-alone PDPs, tweaks to the risk adjustment model, TrOOP calculation, and enhanced plan benefit designs rolled out by CMS make predicting how the market will shake out difficult.

Medicare Reimbursement

The Next Big PBM Deal? Rumored Cigna-Humana Talks Raise Overlap Question

Vigorous regulatory scrutiny is a given, but opinions vary about how much the companies’ respective PBM businesses present a major antitrust risk.

Legal Issues Reimbursement

Banning Spread Pricing on PBMs Alone May Have Little Impact, Study Suggests

As legislation moves forward in Congress, an examination of high-utilization Part D-covered generic drugs concludes that other payers in the supply chain make almost as much money from spread pricing as PBMs do.

Pricing Debate Legislation

‘Transparency-Rx’: Meet The PBM Execs Breaking Rank And Backing Reforms

New coalition of smaller PBMs champions federal policies requiring ‘100% pass-through’ of rebates, with PBMs then paid by a flat, disclosed fee.

Pricing Debate Leadership

Rx Oversight Issues at Federal Workers’ Comp Program Endangered Patients, Audit Says

OWCP says that hiring a PBM will address overprescribing and cost concerns, but a consultant who participated in the audit is skeptical.

Government Payers Reimbursement
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