California files suit against PBMs over insulin prices

The state filed suit Thursday against pharmacy benefit managers CVS Caremark, Express Scripts and OptumRx, alleging they worked with drugmakers to drive up the price of insulin.

By Hailey Mensik • Jan. 13, 2023

Extended subsidies boost ACA marketplace enrollment

Nearly 16 million people have signed up for health coverage through the Affordable Care Act marketplace since open enrollment began Nov. 1

By Hailey Mensik • Jan. 11, 2023

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Surprise Billing

Federal legislation banning surprise bills has hit a barrage of roadblocks, complicating efforts to protect consumers from unexpected out-of-network charges.

By Healthcare Dive staff

Hospitals disappointed with court ruling placing HHS in charge of 340B repayment

The court’s ruling on Tuesday is the latest update in a yearslong legal dispute between safety net hospitals and the government over payment rates.

By Rebecca Pifer Parduhn • Jan. 11, 2023

COVID-19 vaccine prices are going up. It shouldn’t be our focus.

Vaccinating as many people as possible to reduce the spread of respiratory illness that can be especially life-threatening for the youngest and oldest Americans is key, argues vaccine law professor Richard Hughes IV.

By Richard Hughes IV • Jan. 10, 2023

Sen. Bernie Sanders to target high healthcare costs as leader of influential committee

The longtime Congressman and “Medicare for All” proponent will soon assume leadership of the Senate HELP committee, giving him sway in one of the nation’s most broadly influential health policy forums.

By Sydney Halleman • Jan. 9, 2023

FDA approves Alzheimer’s drug from Eisai, Biogen in closely watched decision

The agency’s approval comes months after a large clinical trial showed the drug, called Leqembi, could slow the disease’s progression. Yet experts have raised concerns about its safety.

By Jacob Bell • Jan. 6, 2023

California revises Medicaid contract awards, adding 2 insurers

Five insurers will now receive lucrative contracts to provide managed care services, starting in 2024, in the country’s largest Medicaid market.

By Susan Kelly • Jan. 4, 2023

The portal to resolve surprise bills has been inundated with disputes — SCP Health tops the list

Federal agencies received more disputes in a five-month window than they expected to receive in a full year.

By Samantha Liss • Updated Jan. 9, 2023

The Advocate-Atrium merger closed without an antitrust challenge. What does that mean for competition in 2023?

Health systems have morphed into multi-regional players through acquisitions, but have evaded federal antitrust enforcement, raising questions about the future of policing merger deals.

By Samantha Liss • Dec. 22, 2022

Stakes are high in California’s Medicaid market shakeup

Four insurers that lost out on lucrative contracts in the state’s first-ever competitive process are challenging the state's picks.

By Susan Kelly • Dec. 21, 2022

Judge questions surprise billing ban implementation during court hearing

A federal judge on Tuesday tested the government’s defense concerning a rule designed to help third parties resolve payment disputes between providers and insurers.

By Samantha Liss • Dec. 21, 2022

‘Bravo Congress’: Telehealth groups cheer omnibus extension of COVID-19 flexibilities

Still, the American Telemedicine Association and other virtual care lobbies said there was more to do to enshrine telehealth access into American law.

By Rebecca Pifer Parduhn • Dec. 21, 2022

HHS releases ownership data on nation’s hospitals

“We are pulling back the curtain and letting the sunshine in on hospital and nursing home ownership because it is what the public deserves,” HHS Secretary Xavier Becerra said Tuesday in a statement.

By Samantha Liss • Dec. 21, 2022

Omnibus bill restarts Medicaid checks, lowers Medicare physician pay cuts

President Joe Biden signed the the $1.7 trillion omnibus spending package into law on Dec. 29.

By Sydney Halleman • Updated Jan. 3, 2023

Government watchdog warns of Medicare fraud after relaxing provider requirements

The Government Accountability Office is urging the CMS to resume certain eligibility checks on providers whom they consider at high risk of fraud to the Medicare program. 

By Samantha Liss • Dec. 20, 2022

CMS rule aimed at improving Medicare Advantage draws praise

Proposed changes target prior authorization holdups and misleading advertising while aiming to expand access to behavioral health care and affordable prescriptions.

By Susan Kelly • Dec. 19, 2022

Scan Group, CareOregon to merge, forming $6.8B health plan

Together the two will serve nearly 800,000 Medicaid and Medicare members across five states, giving them greater scale to take on competitors.

By Samantha Liss • Dec. 15, 2022

National health spending reached $4.3 trillion in 2021

Increases in healthcare utilization and insurance coverage were offset by lower government spending on COVID-19, according to new CMS data.

By Rebecca Pifer Parduhn • Dec. 14, 2022

CMS estimates 41.5M people affected by innovation center models since late 2020

The Center for Medicare and Medicaid Innovation is currently operating 33 models studying potential improvements in healthcare payment and delivery.

By Rebecca Pifer Parduhn • Dec. 14, 2022

Maternal health services suffer in states with abortion bans, report finds

States risk driving away healthcare providers who are reluctant to work where their practices will be restricted, according to a Commonwealth Fund analysis.

By Susan Kelly • Dec. 14, 2022

CMS tackles provider availability, exchange regulations in proposed rule

The regulation comes after the ACA exchanges, spurred by financial incentives during the COVID-19 pandemic, reached record enrollment numbers.

By Sydney Halleman • Dec. 13, 2022

COVID-19 vaccine saved millions of lives, study calculates

The vaccines also reduced infections and hospitalizations, which freed up hospital resources, researchers at the Commonwealth Fund and Yale School of Public Health concluded.

By Susan Kelly • Dec. 13, 2022

Variability in Medicare direct contracting savings illustrates promises, pitfalls of value-based care

Accountable care organizations' net savings rates ranged from -29.4% to 29.2% in the 2021 Global and Professional Direct Contracting Model.

By Rebecca Pifer Parduhn • Updated Dec. 13, 2022

Progressive lawmakers call on CMS to cull companies with history of Medicare fraud from ACO REACH

At least 10 organizations with records of healthcare fraud and abuse participated in the direct contracting program last year despite CMS screening requirements, the letter said.

By Rebecca Pifer Parduhn • Updated Dec. 20, 2022

OSHA moves ahead with permanent COVID-19 standards for health workers

The submission for permanent COVID-19 safety standards comes after temporary pandemic requirements for medical facilities were withdrawn last December.

By Hailey Mensik • Dec. 9, 2022