CVS could lose up to $1B next year from MA star ratings drop

Just 21% of CVS’ MA members are currently in plans with a star rating of at least four, down from 87% at the end of 2021, the payer disclosed.

By Rebecca Pifer • May 26, 2023

Two-thirds of Medicaid enrollees unaware of redeterminations, survey finds

The KFF survey found many enrollees weren’t sure whether states are now allowed to remove people from the program, and 27% wouldn’t know where to look for coverage if they were ineligible for Medicaid.

By Emily Olsen • May 25, 2023

AHIP chief executive to step down in October

Matt Eyles will depart after serving nearly five years as CEO of AHIP. The organization is launching a nationwide search for his replacement.

By Sydney Halleman • May 25, 2023

US projected to hit record-low uninsurance rate this year

But as federal aid expires, lower-income Americans — who saw the largest insurance gains during the pandemic — will likely be affected the most, according to experts.

By Rebecca Pifer • May 24, 2023

Biden administration aims to increase Medicaid drug transparency

The notice of proposed rulemaking recommends that the CMS and states get a drug price verification survey tool and negotiate for expensive drugs under Medicaid.

By Brian T. Horowitz • May 24, 2023

House lawmakers, PBM lobby spar over committee hearing

At the latest congressional inquiry into pharmacy benefit managers, lawmakers argued the middlemen profit at the expense of patients and taxpayers.

By Rebecca Pifer • May 24, 2023

Pharma-backed report targets federal clinics for benefiting financially from 340B drug discounts

Those grantees on average are reimbursed almost four times more for 340B prescription drugs than what they pay, and make billions in 340B drug margin, according to the report, which was funded by Gilead Sciences.

By Rebecca Pifer • May 23, 2023

What 3 key congressional hearings last week mean for the industry

Political will seems to be rising to address drivers of growing medical costs and poor access to care, according to lawmaker comments on the Hill.

By Sydney Halleman , Rebecca Pifer • May 19, 2023

Senate scrutinizes MA payment denials, including use of algorithms

“Insurers are in effect denying Americans necessary care in order to fatten and pad their bottom lines, and that phenomenon is unacceptable,” Sen. Richard Blumenthal, D-Conn., said at a subcommittee hearing.

By Rebecca Pifer • May 18, 2023

FTC moves to strengthen Health Breach Notification Rule’s applicability to digital health apps

Regulators are increasingly leaning on the HBNR to crack down on the sharing of sensitive medical data, and the FTC is looking to strengthen its case.

By Rebecca Pifer • May 18, 2023

On heels of Amgen lawsuit, FTC broadens investigation of PBMs

The regulator is probing the business practices of two more drug purchasing organizations, deepening an investigation that began last year.

By Kristin Jensen • May 18, 2023

VA renegotiates tougher EHR modernization contract with Oracle Cerner

The Department of Veterans Affairs said the new contract includes stronger performance metrics and larger credits to the VA if Oracle Cerner doesn’t meet expectations.

By Emily Olsen • May 18, 2023

House committee centers blame on PBMs for rising healthcare costs

Conversation about pharmacy benefit management consolidation dominated the hearing, with lawmakers pointing to the middlemen as drivers of high health costs.

By Sydney Halleman • May 18, 2023

Uninsured rate fell 18% during pandemic, CDC finds

The findings reflect government subsidies aimed at boosting healthcare access during the pandemic, and requirements that states keep Medicaid beneficiaries on their rolls during the public health emergency.

By Brian T. Horowitz • May 17, 2023

House Republicans target Biden admin over hospital price transparency noncompliance

To improve price transparency, the government could consider extending reporting requirements to more provider sites or making compliance a condition of participating in Medicare, witnesses testified in a Tuesday hearing.

By Rebecca Pifer • May 17, 2023

Appellate court pauses ruling blocking ACA preventive care mandate

The temporary administrative stay, which now legally requires health plans to provide preventive care for over 150 million Americans, applies while an appeal of the March case is considered by the court.

By Sydney Halleman • May 16, 2023

Rethinking the area deprivation index: a call for more effective measures to promote health equity

Srilekha Palle, visiting fellow at the Independent Women’s Forum, argues that a key health equity indicator used by the Biden administration has significant limitations that could exclude many underserved communities.

By Srilekha Palle • May 12, 2023

FDA advisers back over-the-counter use of birth control pill

The committee members urged the agency to move quickly to improve access to Perrigo’s contraception pill.

By Kristin Jensen • May 11, 2023

Here’s what will change when the COVID public health emergency ends

Vaccines, which have been crucial to curbing the threat of the virus, will remain free for the vast majority of people in the U.S., but over-the-counter tests will no longer be covered for most.

By Shannon Muchmore • May 10, 2023

Abortion providers in 3 states sue over mifepristone restrictions

The Monday lawsuit seeks to remove safety restrictions on mifepristone or, alternatively, prevent further altering of access to the drug.

By Sydney Halleman • May 9, 2023

Celebrated healthcare heroes are workplace violence victims

Violence prevents nurses, doctors and other professionals from providing uninterrupted, quality patient care, argues Andrew Thum, the director of nursing workforce operations at Jefferson Health in Philadelphia.

By Andrew Thum • May 8, 2023

AHA, hospital groups file court brief asking to restore ACA preventive services mandate

The medical associations said preventive health services are essential to increase longevity and quality of life, and that medical evidence should dictate preventive care recommendations rather than political considerations.

By Brian T. Horowitz • May 8, 2023

CDC Director Walensky to step down in June

Rachel Walensky, who has served as director since 2021, was criticized for the federal government’s handing of the pandemic, announcing in August last year that she planned to reorganize the CDC.

By Sydney Halleman • May 5, 2023

DEA temporarily extends COVID-19 telehealth prescribing flexibility for controlled substances

The agency said on Wednesday that it needs additional time to parse through the 38,000 public comments it received in response to a proposal to reintroduce stricter limits around telehealth prescribing.

By Rebecca Pifer • May 4, 2023

Envision wins $91M in arbitration against UnitedHealthcare

The arbitration panel found UnitedHealthcare “unilaterally reduced reimbursement to Envision clinicians,” in violation of its in-network agreement.

By Sydney Halleman • May 3, 2023