Government: Page 3
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PBM markets lack competition, new paper finds
The American Medical Association’s research, which found that local PBM markets are highly concentrated, is more fuel for critics of the powerful drug middlemen.
By Rebecca Pifer • July 31, 2025 -
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Medicare Part D premiums likely to increase next year
The average monthly bid submitted by insurers for 2026 prescription drug plans increased 33% from last year, according to data released by the CMS.
By Emily Olsen • July 30, 2025 -
Trendline
Labor
Hospitals are navigating persistent labor shortages with the need to cut costs — a source of contention that could leave patients caught in the middle.
By Healthcare Dive staff -
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Judge halts Arkansas law forcing PBMs to sell pharmacies
U.S. District Judge Brian Miller agreed with pharmacy benefit managers that the state’s law may violate the Constitution in granting their request for a preliminary injunction.
By Rebecca Pifer • July 30, 2025 -
Retrieved from Vinay Prasad on May 08, 2025
Vinay Prasad, controversial FDA official, abruptly departs agency
Prasad's exit ends a tumultuous tenure during which he led a reworking of agency guidelines on COVID vaccines and his office got embroiled in controversy over a Duchenne gene therapy.
By Ben Fidler • July 29, 2025 -
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FTC seeks comment on gender-affirming care, weighs enforcement options
The agency said it could use the comments to penalize medical professionals providing gender-affirming care. Scrutiny from the Trump administration has already caused several providers to halt the services for minors.
By Susanna Vogel • July 29, 2025 -
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Top medical association warns RFK Jr. not to overhaul preventive services task force
The health secretary reportedly wants to fire all 16 members of the task force that advises insurers on what services they have to cover under the Affordable Care Act. The American Medical Association thinks that’s a bad idea.
By Rebecca Pifer • July 28, 2025 -
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Trump administration releases AI adoption plan
While the plan rarely mentions healthcare, it is one of the administration’s first steps to set federal policies, which experts say is important to safely deploy the technology in the sector.
By Emily Olsen • July 25, 2025 -
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UnitedHealth confirms it’s under investigation by DOJ
The company said it was complying with criminal and civil investigations from the Justice Department into its Medicare program.
By Sydney Halleman • July 24, 2025 -
Rebecca Pifer/Healthcare Dive
A ‘bastardized’ program: GOP lawmakers eye Medicare Advantage reform
In a hearing this week, Republican legislators appeared open to changing the privatized Medicare program — once a GOP darling that’s fallen out of favor amid concerns about prior authorizations, care denials and profiteering.
By Rebecca Pifer • July 23, 2025 -
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10M people will lose insurance due to GOP policy law: CBO
The final tally from the nonpartisan budget scorekeeper estimates the law will decrease federal healthcare spending by $1.1 trillion over the next decade.
By Emily Olsen • July 23, 2025 -
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Democrat senators warn Medicaid cuts could worsen rural hospital cybersecurity
Funding cuts enacted in the GOP’s massive tax law will push cash-strapped rural providers to deprioritize cyber preparedness, according to Sens. Ron Wyden and Mark Warner.
By Emily Olsen • July 22, 2025 -
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ACA health plan premiums could spike in 2026: report
Insurers are requesting a median premium increase of 15% for 2026 as they grapple with policy uncertainty for plans on the exchanges, according to an analysis from KFF and the Peterson Center on Healthcare.
By Emily Olsen • July 22, 2025 -
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Humana refiles Medicare Advantage star ratings suit
Humana is taking a second bite at the apple to improve its sunken MA stars, filing an edited complaint with a Texas court on Monday. The insurer also announced plans to pare back its prior authorization policies.
By Rebecca Pifer • July 22, 2025 -
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States sue Trump administration over ACA eligibility, enrollment rule
The lawsuit argues the rule would drive up the number of uninsured and saddle states with increased healthcare expenses.
By Emily Olsen • July 21, 2025 -
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Civil monetary penalties against Medicare Advantage, Medicare drug plans rising, CMS data shows
Civil monetary penalties against payers for improperly delaying or denying coverage, hitting members with higher cost sharing than allowed and other issues have already surpassed $3 million this year.
By Rebecca Pifer • July 18, 2025 -
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Judge dismisses Humana’s Medicare Advantage star ratings suit
It’s a significant loss for the insurer, which sued the government late last year after its star ratings plummeted for 2025. Analysts estimate Humana could lose billions of dollars as a result of the decision.
By Rebecca Pifer • Updated July 18, 2025 -
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Trump administration to end Medicaid waivers for continuous enrollment, workforce training
On Thursday, CMS sent letters to states notifying them that it doesn’t plan to approve any new such waivers or extend existing ones in the administration’s latest curtailing of Medicaid.
By Rebecca Pifer • July 18, 2025 -
Ned Pagliarulo/Healthcare Dive
33 states pick up CMS program to pay for sickle cell gene therapies
States representing about 84% of Medicaid beneficiaries are participating in an initiative that enables the government to negotiate pay-for-performance deals with the manufacturers of products like Casgevy and Lyfgenia.
By Ben Fidler • July 16, 2025 -
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Medicaid cuts could have ‘far-reaching’ healthcare, economic impacts: study
Coverage losses linked to the massive tax and policy law could drive up excess deaths and preventable hospitalizations by 2034, according to the study in JAMA Health Forum.
By Emily Olsen • July 16, 2025 -
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Medicare targets site neutrality, price transparency in hospital outpatient rule
The proposed rule would send an additional $8 billion to hospitals next year, but includes a number of other policies hospital groups have criticized.
By Sydney Halleman , Emily Olsen • July 16, 2025 -
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Judge nixes Biden-era rule removing medical debt from credit reports
It’s a victory for the credit reporting industry and a loss for advocates of reducing medical debt. The Trump administration had declined to defend the rule in court.
By Rebecca Pifer • July 15, 2025 -
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CMS proposes rule aligning Medicare physician payment with ‘Big Beautiful Bill,’ MACRA
The sweeping regulation proposes notable changes to how Medicare pays physicians, but overall results in a modest bump to reimbursement in 2026.
By Rebecca Pifer • July 15, 2025 -
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CMS proposes covering renal denervation for hypertension
The proposed determination recommends Medicare coverage for both radiofrequency- and ultrasound-based renal denervation.
By Susan Kelly • July 11, 2025 -
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Alignment Healthcare wins partial victory in Medicare Advantage star ratings case
A judge agreed that the CMS should recalculate the scores for one Alignment plan in Arizona. Now, all of the insurer’s MA members are in plans rated four stars or higher.
By Rebecca Pifer • July 10, 2025 -
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CVS Omnicare ordered to pay $949 million in government fraud case
CVS plans to appeal the judgment, which comes after a jury ruled that its long-term care pharmacy benefits manager illegally charged Medicare, Medicaid and Tricare for prescription drugs for almost a decade.
By Rebecca Pifer • July 9, 2025
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