CMS says states could lose funding over Medicaid redeterminations issues

The interim final rule, which is set to go into effect Wednesday, comes as nearly 11.8 million people have been removed from the safety-net insurance.

By Emily Olsen • Dec. 5, 2023

CVS overhauls how its retail pharmacies charge for prescription drugs

Under the new model, CVS’ pharmacy network will price drugs based on the amount the company paid for them, plus a defined markup and additional pharmacist fee.

By Rebecca Pifer • Dec. 5, 2023

Explore the Trendline➔

The Healthcare Dive Outlook on 2023

COVID-19 will continue to be a key presense in 2023, as the public health emergency is slated to end in May, sparking a major transition for the industry.

By Healthcare Dive staff

A Cigna-Humana merger could face a long regulatory delay. But it might get approved.

As rumors swirl that the two major health insurers are inching toward a merger, experts say antitrust agencies have grounds to block a deal — but may not be successful.

By Rebecca Pifer • Dec. 4, 2023

Enhanced human potential: How customer service technology increases empathy

Elevance Health’s Geeta Wilson talks about improving operational efficiencies while enhancing member and associate satisfaction.

By Christopher Patterson, VP Product Strategy, Pegasystems • Dec. 4, 2023

North Carolina Medicaid expansion kicks in

About 600,000 more people in the state now have access to the safety-net insurance coverage.

By Rebecca Pifer • Dec. 1, 2023

Medicare Advantage rate change bedevils UnitedHealth’s 2024 outlook

UnitedHealth’s MA growth could be depressed next year thanks to a rate notice from the CMS that’s deeply unpopular with insurers, management said during an investor day.

By Rebecca Pifer • Nov. 30, 2023

Highmark Health’s insurance business boosts earnings

The insurance arm pushed the healthcare parent company to positive results during the first nine months of 2023 after its provider arm, Allegheny Health, reported an operating loss.

By Susanna Vogel • Nov. 29, 2023

Cigna, Humana in talks to merge: WSJ

The merger would have major effects on the makeup of the U.S. health insurance industry, and would almost certainly face a regulatory challenge.

By Rebecca Pifer • Nov. 29, 2023

Global medical costs to dip in 2024 — but respite may not last long, research finds

Medical costs will continue to rise over the next few years, according to WTW. Surveyed insurers blamed expensive medical technologies and an overuse of health services.

By Susanna Vogel • Nov. 29, 2023

Majority of Medicaid enrollees satisfied with plans, despite flaws, survey finds

Medicaid enrollees are more likely to understand and be satisfied with their plans, despite reporting poorer health outcomes, according to a new report from KFF. 

By Susanna Vogel • Nov. 29, 2023

AI to take center stage in healthcare in 2024

Five predictions on how AI will change healthcare.

By Robert Connely, Global Market Leader for Healthcare, Pegasystems • Nov. 27, 2023

Average per-worker cost of health benefits rose by 5.2% in 2023: survey

Inflation is a contributor to the increase, but rising prescription drug costs are likely to have a longer-term impact, according to a Mercer report.

By Emily Olsen • Nov. 22, 2023

Insurers’ financial outlook stable despite higher MA utilization: Moody’s

Publicly traded health insurers’ financial results held steady in the third quarter, boosted by strong investment income and membership growth, according to the credit ratings agency.

By Emily Olsen • Nov. 22, 2023

CMS proposes stricter network adequacy standards for plans in state-run ACA exchanges

Beginning in 2025, plans sold in state-based exchanges would be required to meet time and distance standards for provider access under a new rule proposed Wednesday.

By Rebecca Pifer • Nov. 16, 2023

Centene names new COO following leadership turnover

Current SVP Susan Smith will take the reins as the health insurer’s chief operating executive starting next year.

By Rebecca Pifer • Nov. 15, 2023

UnitedHealth sued over use of algorithm to deny care for MA members

The lawsuit alleges UnitedHealth used nH Predict to deny claims despite the algorithm’s determinations being overturned in more than 90% of appeals.

By Rebecca Pifer • Nov. 15, 2023

State Medicaid officials project enrollment nosedive next year amid unwinding

Enrollment in the safety-net insurance program could plummet 8.6% in the 2024 fiscal year — the largest year-over-year drop since 1998, according to KFF.

By Rebecca Pifer • Nov. 14, 2023

New AMA policies focus on GLP-1 coverage, resisting corporate medicine

The lobbying group advanced a range of policy resolutions it says will advance access to patient care at its annual interim meeting.

By Susanna Vogel • Nov. 14, 2023

How payers can advance health equity as part of coordinated action

When discussing the gap between the status quo and safe, high-quality healthcare, many organizations realize that improving health equity is a moral and economic imperative as the business case for equity is well-documented.

Nov. 13, 2023

Optum Rx moves 8 insulins to preferred formulary status as pressure mounts on PBMs

The drugs shifting to preferred status — meaning they’ll be available for under $35 per month in out-of-pocket costs — were previously on tier three or excluded altogether from the pharmacy benefit manager’s formulary lists.

By Rebecca Pifer • Nov. 10, 2023

Medicare Advantage seniors have better health outcomes, study finds

New research from Harvard and Inovalon found MA beneficiaries had fewer hospital readmissions, fewer preventable hospitalizations and lower rates of high-risk medication use than those in traditional Medicare.

By Rebecca Pifer • Nov. 9, 2023

Biggest takeaways from health insurers’ third-quarter earnings

Many payers beat Wall Street expectations in the quarter, despite ongoing utilization concerns. Other hot topics? Medicare Advantage stars, Medicaid redeterminations, individual exchange growth and GLP-1s.

By Rebecca Pifer • Nov. 8, 2023

Biden administration proposes capping broker payment in MA, following pressure

The new proposed rule is meant to stop brokers from steering beneficiaries to plans based on excessive compensation. It’s regulators’ latest move to curb Medicare Advantage marketing misconduct following a push from lawmakers.

By Rebecca Pifer • Nov. 7, 2023

Medicaid disenrollments pass 10M as states continue eligibility checks

States have assessed the eligibility of 28 million Americans to date, and terminated coverage for 35% of them, according to the latest data from KFF.

By Rebecca Pifer • Nov. 6, 2023

CMS finalizes 2024 Medicare hospital, doctor payments, 340B fix and price transparency requirements

Regulators finalized a number of rules Thursday with sweeping implications for providers in the Medicare program, including rates for next year that doctors and hospitals slammed as insufficient.

By Rebecca Pifer • Nov. 3, 2023