1/ How closely do health plans’ drug #utilizationmanagement (UM) policies align with #clinicalguidelines? CEVR and NPC examined policies for 389 drug-indication pairs from 18 commercial insurers. Here’s a thread on what we found:
July 7, 2025 at 8:18 PM
1/ How closely do health plans’ drug #utilizationmanagement (UM) policies align with #clinicalguidelines? CEVR and NPC examined policies for 389 drug-indication pairs from 18 commercial insurers. Here’s a thread on what we found:
#Priorauthorization #UtilizationManagement for costly 2nd-line 💊 is understandable but nearly one-half of plans have quantity limits for generic ondansetron, a cheap ($16 for 60 8mg tabs) & effective 1st-line drug
Make this make sense.
#fixPriorAuth
@michaelannica.bsky.social
@jamanetworkopen.com
Make this make sense.
#fixPriorAuth
@michaelannica.bsky.social
@jamanetworkopen.com
Prior Authorization, Quantity Limits, and Step Therapy for Antiemetics
This cross-sectional study evaluates whether antiemetic drugs for patients with cancer who have Patient Protection and Affordable Care Act (ACA) Marketplace or Medicaid plans are subject to utilizatio...
jamanetwork.com
October 7, 2025 at 1:39 PM
#Priorauthorization #UtilizationManagement for costly 2nd-line 💊 is understandable but nearly one-half of plans have quantity limits for generic ondansetron, a cheap ($16 for 60 8mg tabs) & effective 1st-line drug
Make this make sense.
#fixPriorAuth
@michaelannica.bsky.social
@jamanetworkopen.com
Make this make sense.
#fixPriorAuth
@michaelannica.bsky.social
@jamanetworkopen.com
Prior authorization works better when the entire process stays connected.
From intake to clinical review, criteria checks, decisions, communication, and appeals — teams need visibility across every step.
#PriorAuthorization #UtilizationManagement #HealthcareWorkflows #HealthcareAI
From intake to clinical review, criteria checks, decisions, communication, and appeals — teams need visibility across every step.
#PriorAuthorization #UtilizationManagement #HealthcareWorkflows #HealthcareAI
July 1, 2026 at 1:18 PM
Prior authorization works better when the entire process stays connected.
From intake to clinical review, criteria checks, decisions, communication, and appeals — teams need visibility across every step.
#PriorAuthorization #UtilizationManagement #HealthcareWorkflows #HealthcareAI
From intake to clinical review, criteria checks, decisions, communication, and appeals — teams need visibility across every step.
#PriorAuthorization #UtilizationManagement #HealthcareWorkflows #HealthcareAI
Prior authorization works better when every step stays connected.
Request intake, clinical review, criteria checks, decisions, communication, and appeals should not operate as separate manual processes.
#PriorAuthorization #UtilizationManagement #HealthcareWorkflows #HealthcareAI
Request intake, clinical review, criteria checks, decisions, communication, and appeals should not operate as separate manual processes.
#PriorAuthorization #UtilizationManagement #HealthcareWorkflows #HealthcareAI
July 31, 2026 at 12:48 PM
Prior authorization works better when every step stays connected.
Request intake, clinical review, criteria checks, decisions, communication, and appeals should not operate as separate manual processes.
#PriorAuthorization #UtilizationManagement #HealthcareWorkflows #HealthcareAI
Request intake, clinical review, criteria checks, decisions, communication, and appeals should not operate as separate manual processes.
#PriorAuthorization #UtilizationManagement #HealthcareWorkflows #HealthcareAI
Miss our May newsletter?
Read the latest edition here: bit.ly/3RIiVTm
Want to receive future newsletters? Feel free to reach out to our team—we’d be happy to keep you connected.
#HealthcareIT #CareManagement #UtilizationManagement #HealthTech #newsletter
Read the latest edition here: bit.ly/3RIiVTm
Want to receive future newsletters? Feel free to reach out to our team—we’d be happy to keep you connected.
#HealthcareIT #CareManagement #UtilizationManagement #HealthTech #newsletter
Blog – Elligint Health
bit.ly
May 18, 2026 at 4:15 PM
Miss our May newsletter?
Read the latest edition here: bit.ly/3RIiVTm
Want to receive future newsletters? Feel free to reach out to our team—we’d be happy to keep you connected.
#HealthcareIT #CareManagement #UtilizationManagement #HealthTech #newsletter
Read the latest edition here: bit.ly/3RIiVTm
Want to receive future newsletters? Feel free to reach out to our team—we’d be happy to keep you connected.
#HealthcareIT #CareManagement #UtilizationManagement #HealthTech #newsletter
Sneak peek 👇
Risk scores are everywhere. Activation is not.
This is just a glimpse of our conversation with @PrealizeHealth on pressure testing your CM & UM platform.
Keep an eye our for the full webinar release on Monday!
#CareManagement #UtilizationManagement #ValueBasedCare #Elliginthealth
Risk scores are everywhere. Activation is not.
This is just a glimpse of our conversation with @PrealizeHealth on pressure testing your CM & UM platform.
Keep an eye our for the full webinar release on Monday!
#CareManagement #UtilizationManagement #ValueBasedCare #Elliginthealth
February 27, 2026 at 10:09 PM
Sneak peek 👇
Risk scores are everywhere. Activation is not.
This is just a glimpse of our conversation with @PrealizeHealth on pressure testing your CM & UM platform.
Keep an eye our for the full webinar release on Monday!
#CareManagement #UtilizationManagement #ValueBasedCare #Elliginthealth
Risk scores are everywhere. Activation is not.
This is just a glimpse of our conversation with @PrealizeHealth on pressure testing your CM & UM platform.
Keep an eye our for the full webinar release on Monday!
#CareManagement #UtilizationManagement #ValueBasedCare #Elliginthealth
California lawmakers are tackling the urgent issue of healthcare access with a groundbreaking bill that could eliminate prior authorization for mental health emergencies.
Learn more here
#CA #MentalHealthReform #UtilizationManagement #CitizenPortal
Learn more here
#CA #MentalHealthReform #UtilizationManagement #CitizenPortal
California Assembly reviews AB 384 to eliminate prior authorizations for mental health emergencies
Assemblymember Connolly presents AB 384 to reform mental health care access in emergencies.
citizenportal.ai
April 23, 2025 at 7:01 PM
California lawmakers are tackling the urgent issue of healthcare access with a groundbreaking bill that could eliminate prior authorization for mental health emergencies.
Learn more here
#CA #MentalHealthReform #UtilizationManagement #CitizenPortal
Learn more here
#CA #MentalHealthReform #UtilizationManagement #CitizenPortal
🎥 CHBRP in a Minute | Episode 2: Utilization Management
Episode 2 is here! Follow along as we break down utilization management and other health policy topics, one minute at a time.
#CHBRP #UtilizationManagement #HealthPolicy
Episode 2 is here! Follow along as we break down utilization management and other health policy topics, one minute at a time.
#CHBRP #UtilizationManagement #HealthPolicy
July 24, 2026 at 8:01 PM
🎥 CHBRP in a Minute | Episode 2: Utilization Management
Episode 2 is here! Follow along as we break down utilization management and other health policy topics, one minute at a time.
#CHBRP #UtilizationManagement #HealthPolicy
Episode 2 is here! Follow along as we break down utilization management and other health policy topics, one minute at a time.
#CHBRP #UtilizationManagement #HealthPolicy
Miss our June newsletter?
Read June's edition here: elliginthealth.com/news/june-20...
Want to receive future newsletters? Feel free to reach out to our team—we’d be happy to keep you connected.
#HealthcareIT #CareManagement #UtilizationManagement #HealthTech #Newsletter
Read June's edition here: elliginthealth.com/news/june-20...
Want to receive future newsletters? Feel free to reach out to our team—we’d be happy to keep you connected.
#HealthcareIT #CareManagement #UtilizationManagement #HealthTech #Newsletter
News & Media
elliginthealth.com
June 29, 2026 at 10:46 PM
Miss our June newsletter?
Read June's edition here: elliginthealth.com/news/june-20...
Want to receive future newsletters? Feel free to reach out to our team—we’d be happy to keep you connected.
#HealthcareIT #CareManagement #UtilizationManagement #HealthTech #Newsletter
Read June's edition here: elliginthealth.com/news/june-20...
Want to receive future newsletters? Feel free to reach out to our team—we’d be happy to keep you connected.
#HealthcareIT #CareManagement #UtilizationManagement #HealthTech #Newsletter
LifeNextDaily News!
Worried about healthcare? New research quantifies the risks of utilization management policies & their impact on you! #UtilizationManagement #HealthcareRisk #PatientCare
Click here↓↓↓
Worried about healthcare? New research quantifies the risks of utilization management policies & their impact on you! #UtilizationManagement #HealthcareRisk #PatientCare
Click here↓↓↓
Utilization Management Risk Factors Unveiled | GameFi News
Discover the hidden dangers of utilization management policies. New research reveals key risks & their impact on patient care.
lifenextdaily.com
June 6, 2025 at 4:00 AM
LifeNextDaily News!
Worried about healthcare? New research quantifies the risks of utilization management policies & their impact on you! #UtilizationManagement #HealthcareRisk #PatientCare
Click here↓↓↓
Worried about healthcare? New research quantifies the risks of utilization management policies & their impact on you! #UtilizationManagement #HealthcareRisk #PatientCare
Click here↓↓↓
Vermont lawmakers are debating significant changes to healthcare management, including a new $25,000 threshold for 'high-dollar' claims and adjustments to prior authorization exemptions—what does this mean for patients and providers?
Click to read more!
#VT #UtilizationManagement
Click to read more!
#VT #UtilizationManagement
Committee hears mixed views on prior authorization changes, a $25,000 'high‑dollar' threshold and a 1332 reinsurance authorization
Witnesses and regulators debated changes to utilization management — including a $25,000 numeric definition for 'high‑dollar' claims and narrowing of primary‑care prior‑authorization exemptions — and authorized agencies to apply for a Section 1332 reinsurance waiver to potentially lower premiums with federal pass‑through funding.
citizenportal.ai
January 31, 2026 at 11:19 AM
Vermont lawmakers are debating significant changes to healthcare management, including a new $25,000 threshold for 'high-dollar' claims and adjustments to prior authorization exemptions—what does this mean for patients and providers?
Click to read more!
#VT #UtilizationManagement
Click to read more!
#VT #UtilizationManagement
.@Capitol_Weekly features @ArthritisFdn & @CalRheum piece supporting #AB374 which would help ensure that treatments are based on the counsel of a doctor, not an insurance company. #steptherapy #utilizationmanagement https://bit.ly/38Qt5s0
Eliminate the guessing game in step therapy - Capitol Weekly
Utilized by both public and private insurers, step therap...
bit.ly
March 22, 2025 at 10:22 AM
.@Capitol_Weekly features @ArthritisFdn & @CalRheum piece supporting #AB374 which would help ensure that treatments are based on the counsel of a doctor, not an insurance company. #steptherapy #utilizationmanagement https://bit.ly/38Qt5s0
How Prior Authorization Impacts Care, Cost, and Clinical Workflows?
staffingly.com/how-prior-au...
#PriorAuthorization #HealthcareAdmin #UtilizationManagement #HealthTech #Staffingly
staffingly.com/how-prior-au...
#PriorAuthorization #HealthcareAdmin #UtilizationManagement #HealthTech #Staffingly
July 7, 2025 at 7:14 PM
How Prior Authorization Impacts Care, Cost, and Clinical Workflows?
staffingly.com/how-prior-au...
#PriorAuthorization #HealthcareAdmin #UtilizationManagement #HealthTech #Staffingly
staffingly.com/how-prior-au...
#PriorAuthorization #HealthcareAdmin #UtilizationManagement #HealthTech #Staffingly