Payer
-
Rebecca Pifer Parduhn/Healthcare Dive
State Medicaid directors defend program integrity as Dems cry foul in House hearing
The Trump administration says its war on fraud applies to the entire country. But only blue states have had their Medicaid funding threatened or deferred, Democrats argued in a House subcommittee hearing Thursday.
By Rebecca Pifer Parduhn • June 26, 2026 -
Getty Images
US health spending spikes to $5.7T in 2025, though growth should moderate, CMS finds
Utilization — not cost growth — continues to accelerate spending, government actuaries said. Rising prescription drug spending, including on GLP-1s, is especially acute.
By Rebecca Pifer Parduhn • June 24, 2026 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
Samantha Liss/Healthcare Dive
Centene adds JPMorgan veteran to board
Incoming board member Lauren Tyler has more than 30 years of leadership experience in the finance world, which could help Centene navigate the challenging operating environment facing insurers.
By Rebecca Pifer Parduhn • June 24, 2026 -
Joe Raedle via Getty Images
Florida launches probe into CVS for alleged anticompetitive pharmacy practices
The investigation by Florida’s attorney general comes as states look to check pharmacy benefit managers for allegedly driving up drug costs.
By Emily Olsen • June 24, 2026 -
Permission granted by CVS Caremark
Sponsored by CVS CaremarkDisaggregation vs. integration: Why an integrated pharmacy benefits strategy is the right choice
Health plans need to understand why integration is still the most impactful option for their pharmacy benefits model.
By Ed DeVaney, EVP and President, CVS Caremark • June 22, 2026 -
Getty Images
PCMA sues to exempt PBMs from Illinois drug law
It’s the second major lawsuit the pharmacy benefit manager lobby has filed against a state law reforming the industry in recent weeks.
By Rebecca Pifer Parduhn • June 18, 2026 -
Getty Images
Employers plan to shift more health costs to employees
Employers are considering raising premiums and increasing other forms of cost sharing as they grapple with stubbornly rising health costs, according to a new survey from Mercer.
By Sydney Halleman • June 18, 2026 -
Kayla Bartkowski via Getty Images
CMS recalculates Medicare Advantage stars after Clover lawsuit loss, but not a freebie for plans
Regulators are locking in new 2026 stars for plans if they’re higher under the new methodology. But the recalculation basically results in no change to average star ratings unless you’re Clover, analysts say.
By Rebecca Pifer Parduhn • June 18, 2026 -
DNY59 via Getty Images
CBO asks for more No Surprises research
The No Surprises Act “might not have the effects that CBO anticipated,” the agency wrote in petitioning for more research into the 2020 law’s effect on healthcare prices and other trends. It’s a welcome development for payers.
By Rebecca Pifer Parduhn • June 17, 2026 -
Joe Raedle via Getty Images
Fewer insurers participating in ACA marketplaces amid policy turmoil, KFF finds
The average number of issuers fell from a record high of 9.6 per state in 2025 to just nine this year, according to the health policy research group.
By Emily Olsen • June 17, 2026 -
Getty Images
Express Scripts, PCMA sue to block Tennessee law breaking up PBMs and pharmacies
Express Scripts and the PBM lobby are following in CVS Caremark’s footsteps in filing complaints challenging the FAIR Rx Act, which was passed earlier this year despite vehement opposition from PBMs.
By Rebecca Pifer Parduhn • June 16, 2026 -
Alamy
Centene offers employee buyouts amid membership losses
Most of Centene’s 61,000 employees will be eligible to apply for voluntary separation. But the program doesn’t amount to a complete overhaul of the company, a spokesperson said.
By Rebecca Pifer Parduhn • June 16, 2026 -
Getty Images
Judge vacates most of controversial 2025 ACA enrollment, eligibility rule
Friday’s decision is a victory for insurance advocates. But, given many of the rule’s provisions were codified in the GOP’s “Big Beautiful Bill,” it’s not a panacea for the ACA.
By Rebecca Pifer Parduhn • June 15, 2026 -
Stock.Adobe.com/Johnér
Sponsored by Milliman MedInsightData analytics for payers: Improving maternal health outcomes while reducing total cost of care
How health plans can use analytics to improve maternal care and reduce avoidable utilization
June 15, 2026 -
JHVEPhoto via Getty Images
UnitedHealth, FTC reach proposed settlement in insulin case
The tentative deal comes months after CVS reached a proposed settlement in the lawsuit alleging major PBMs are inflating insulin costs. Cigna has already settled with the FTC.
By Emily Olsen • June 12, 2026 -
Getty Images
Major Medicare Advantage insurers appear to deny care for profit, federal watchdog finds
MA insurers commonly deny requests for post-acute care — but none more frequently than UnitedHealth, Humana and CVS, the HHS OIG said. Insurers were not happy about the findings.
By Rebecca Pifer Parduhn • June 12, 2026 -
Kayla Bartkowski via Getty Images
CMS creates office dedicated to health technology
The Office of Health Technology and Products is the latest technology development from the CMS as it doubles down on digital tools.
By Emily Olsen • June 12, 2026 -
Alex Wong via Getty Images
CMS increases oversight of state Medicaid demonstrations
States will have to provide more rigorous financial analyses for their Medicaid demonstrations beginning in 2027, according to new federal guidance.
By Sydney Halleman • June 12, 2026 -
Getty Images
Health plans say AI is pushing healthcare costs higher
Nearly 70% of surveyed health plans said providers’ use of AI documentation and coding tools was a top three trend inflating commercial healthcare costs next year, according to a new report from PwC.
By Emily Olsen • June 11, 2026 -
Getty Images
Medicare insolvency date creeps forward thanks to ‘Big Beautiful Bill,’ trustees find
The trust fund underpinning Medicare’s hospital benefit is set to run out of money one quarter earlier than previously expected as tax cuts in the GOP’s reconciliation legislation shrink Medicare’s revenue.
By Rebecca Pifer Parduhn • June 11, 2026 -
Neiu20001 via Getty Images
Humana divests interest in end-of-life provider Gentiva valued at $900M
The insurer is offloading its interest in the massive end-of-life care provider to an undisclosed group of investors, amid widespread concern about private investors’ activity in healthcare.
By Rebecca Pifer Parduhn • June 11, 2026 -
Getty Images
Americans mostly blame insurers for rising healthcare costs, survey finds
AHIP argued the survey, which was commissioned by a pro-hospital advocacy group, is a blatant attempt by hospitals to deflect the blame for ever-higher spending.
By Rebecca Pifer Parduhn • June 10, 2026 -
Getty Images
House committee takes step toward blocking Medicare AI prior authorization pilot
It’s another sign of lawmakers’ concern about the pilot, which has been lambasted for delaying care to seniors.
By Emily Olsen • June 10, 2026 -
Getty Images
Illinois awards new Medicaid contracts
The state said it intends to divvy out new contracts, which represent tens of billions of dollars in revenue for each awardee, to six insurers. Winners are mostly incumbents, except for Humana.
By Rebecca Pifer Parduhn • Updated June 10, 2026 -
Getty Images
Cities sue to block ACA rule for increasing uninsured rate
City leaders said the regulation risks undermining the Affordable Care Act exchanges and adding new costs for local governments. Now, they’re suing to overturn the rule.
By Sydney Halleman • June 8, 2026
