Real answers to the questions patients actually ask about insurance and denials.
Federal law requires health insurers to respond to urgent prior authorization appeals within 72 hours. When your medication is denied and you have a medical emergency or urgent need, this rule can be the difference between getting treatment and waiting weeks.
Read full article→Medicaid work requirements in several states can affect your prescription drug coverage if you do not meet work, training, or volunteer hour requirements. Understanding exemptions and reporting requirements can help you maintain medication access.
Read full article→Health data breaches affect millions of Americans each year. When your medical information is compromised, federal and state laws provide specific protections and notification rights that many patients do not know about.
Read full article→Botox for chronic migraines is FDA-approved and covered by most insurance plans, but getting approval often requires extensive documentation and appeals. Understanding coverage criteria and building strong clinical evidence can improve your chances of approval.
Read full article→In March 2026, the FDA announced new steps to further streamline biosimilar development and make biologic medicines more affordable. This announcement continues a policy direction the agency has been pursuing for several years, and it has real implications for anyone who takes a specialty biologic.
Read full article→On March 30, 2026, the FDA approved Ponlimsi (denosumab-adet), the first biosimilar to Prolia, manufactured by Teva Pharmaceutical. The approval covers every indication that Prolia is already approved for.
Read full article→For three years during the COVID-19 pandemic, states were not allowed to disenroll anyone from Medicaid. It was called the continuous enrollment requirement, and it was a federal protection that kept millions of people covered even if their income or circumstances changed.
Read full article→On January 21, 2026, the U.S. Food and Drug Administration granted Breakthrough Therapy designation to soficabtagene geleucel (WU-CART-007), an investigational allogeneic CAR-T cell therapy for relapsed or refractory T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma.
Read full article→A Komodo Health analysis published in July 2025, based on a review of more than 4 billion insurance claims, found that prescription denials by private insurers increased by approximately 25 percent between 2016 and 2023.
Read full article→The Inflation Reduction Act gave Medicare the power to negotiate drug prices directly with manufacturers for the first time in the program's history. The first ten negotiated prices took effect January 1, 2026. Now CMS has announced the second round: fifteen more drugs with negotiated Maximum Fair Prices taking effect January 1, 2027.
Read full article→If you receive health insurance through your employer, the denial you just received is governed by federal law, not state law. This matters more than you might think.
Read full article→Your prior authorization went through. Your insurance company said yes. But when you get to the pharmacy, your copay is $1,800. You cannot afford it, so you do not fill the prescription.
Read full article→Showing 12 of 41 posts
Want insights delivered to your inbox? Subscribe to our newsletter