Cigna sues CVS, former pharmacy head Bricker over exec’s departure

In a lawsuit filed Thursday, Cigna alleged that Amy Bricker’s appointment to chief product officer of CVS’s consumer segment places the payer’s trade secrets at risk and violates her noncompete agreement.

By Rebecca Pifer • Jan. 27, 2023

Employers ‘disappointed’ in health plan performance, study finds

Health plans earned a lower average rating in the Leapfrog Group’s latest rankings than in previous years.

By Hailey Mensik • Jan. 26, 2023

Explore the Trendline➔

Payer/Provider relationships

As M&A intensifies and companies are more likely to embrace more holistic and value-based care models, partnerships have become more closely intertwined.

By Healthcare Dive staff

Upcoming Medicaid redeterminations could hamper hospitals, payers

Medicaid eligibility checks beginning in April will likely curb hospital revenue and enrollment growth for payers, Moody's Investors Service said in a report.

By Hailey Mensik • Jan. 26, 2023

Record-breaking 16.3M people signed up for ACA coverage

The 2023 enrollment numbers reflect a broader policy push from the Biden administration to increase insurance coverage, especially during the pandemic.

By Sydney Halleman • Jan. 25, 2023

Will Elevance’s Louisiana acquisition kick off BCBS consolidation wave?

The proposed purchase reminds some industry experts of a period beginning in the 1990s, when nonprofit BCBS plans were acquired by for-profit groups.

By Samantha Liss • Jan. 25, 2023

Elevance reports $6B profit in 2022 on higher medical membership

The results come days after the insurer said it plans to buy Blue Cross and Blue Shield of Louisiana, a deal that would expand its reach to 15 states. 

By Samantha Liss • Jan. 25, 2023

CVS, Rush partner on new ACO for Chicago Medicare patients

Rush University will be the only Chicago-area academic medical center participating in CVS’ first accountable care organization in ACO REACH.

By Rebecca Pifer • Jan. 24, 2023

Elevance to acquire Blue Cross and Blue Shield of Louisiana

The deal will add 2 million members to Elevance’s rolls and push the insurer into its 15th state.

By Samantha Liss • Jan. 24, 2023

Cigna-owned Express Scripts taps new president

Previously, Adam Kautzner led pharmaceutical and retail network contracting and drug sourcing as vice president of supply chain for the PBM and Accredo Pharmacy.

By Sydney Halleman • Jan. 19, 2023

Major government ACOs to cover 13.2M people this year

Accountable care organizations and value-based care advocates cheered the news, with the National Association of ACOs calling 2023 a “turning point” for growth.

By Rebecca Pifer • Jan. 18, 2023

Uninsured rate fell for those historically lacking coverage

Researchers in an HHS report said policies like Medicaid continuous coverage and premium tax credits were key to the reduction.

By Shannon Muchmore • Jan. 17, 2023

UnitedHealth, flush off 2022 momentum, eyes membership, value-based growth

Looking forward, UnitedHealth expects growth of its membership rolls, an increase in fully capitated lives in Optum Health and an acceleration of Optum Insight’s integration with Change Healthcare.

By Rebecca Pifer • Jan. 13, 2023

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

Key trends for payers and providers in 2023

Providers are likely to clash with payers over rate hikes after a year of intense cost pressures.

By Samantha Liss • Jan. 11, 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

Eisai, in pricing new Alzheimer’s drug, tries to sidestep controversy

The pharma set the average annual cost of it and Biogen’s newly approved medicine Leqembi to $26,500, below the cost of the companies’ earlier drug Aduhelm but above one estimate of cost effectiveness.

By Ned Pagliarulo • 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

Centene reaches $44M settlement with Iowa

It’s the latest deal in a string of settlements to resolve allegations the nation’s largest Medicaid managed care organization overcharged states for pharmacy services.

By Samantha Liss • Dec. 21, 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

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

Texas Medical Association heads to court again in second challenge to surprise billing ban

The TMA is continuing to argue the surprise billing ban unfairly benefits insurers. It will argue before the same judge who previously sided with the group in a separate but similar case.

By Samantha Liss • Dec. 19, 2022