Insurers closed out 2024 on shaky footing

Operating income fell for all but two major payers’ insurance divisions in the fourth quarter. And 2025 may be no better, after many insurers released outlooks suggesting medical costs will continue to rise.

By Rebecca Pifer • Feb. 25, 2025

Physicians say prior authorization stands in the way of medically necessary care

Physicians surveyed by the American Medical Association say prior authorization can cause care delays or force patients to abandon treatment. Denials could also increase as insurers adopt AI to review claims.

By Susanna Vogel • Feb. 25, 2025

Explore the Trendline➔

Payer/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

Express Scripts, Caremark, Optum Rx plan to appeal effort to block FTC lawsuit

The “Big Three” PBMs are kicking their suit up to the 8th Circuit and, in the meantime, are once again asking a Missouri district judge to halt the FTC’s administrative case against them.

By Rebecca Pifer • Feb. 24, 2025

Medicaid cuts could worsen home care worker shortage: KFF

States have increased provider payment rates to address workforce shortages, but they may have to cut back if spending cuts hit Medicaid, according to the health policy researcher.

By Emily Olsen • Feb. 20, 2025

FTC case against Caremark, Express Scripts, Optum Rx can move forward, judge rules

A Missouri district court judge on Tuesday said stopping the FTC’s suit against the Big Three PBMs would be “against the public’s interest.” 

By Rebecca Pifer • Feb. 20, 2025

Humana plans to add up to 30 more primary care centers this year

The new centers are being built or acquired in 11 of the 15 states where Humana’s primary care network already has a presence.

By Rebecca Pifer • Updated Feb. 19, 2025

CVS taps Ed DeVaney to head Caremark

DeVaney was named president of the pharmacy benefit manager after serving in the interim role since December. 

By Emily Olsen • Feb. 19, 2025

MultiPlan rebrands as Claritev amid alleged price-fixing lawsuits

The company has faced a spate of lawsuits, including recent litigation by the American Medical Assocation that claimed it colluded with insurers to underpay providers for out-of-network care. 

By Emily Olsen • Feb. 18, 2025

Trump administration slashes funding for ACA navigators

The CMS on Friday announced a record cut to funding for community groups that help consumers learn about and select ACA plans, suggesting President Donald Trump plans to once again chip away at the exchanges.

By Rebecca Pifer • Feb. 18, 2025

RFK Jr. confirmed as HHS secretary

Robert F. Kennedy Jr., a prominent vaccine critic, was confirmed Thursday by the U.S. Senate in a 52-48 vote to serve as the nation’s top health official.

By Emily Olsen • Feb. 13, 2025

GOP calls for $1.5T in cuts, much of which could come from healthcare

House Republicans unveiled their budget wish list last week, which directs the Energy and Commerce Committee — which oversees Medicare and Medicaid — to find $880 billion in savings.

By Rebecca Pifer • Feb. 13, 2025

CVS slashes profit in 2024 as high medical costs hit Aetna

However, the healthcare giant beat Wall Street expectations for earnings and revenue in the fourth quarter, sending its stock soaring on Wednesday. 

By Emily Olsen • Feb. 12, 2025

Large healthcare companies are redistributing most of their profits to shareholders, study finds

Researchers suggested that policymakers encourage reinvestment of capital into patient care and limit share buybacks based on the findings.

By Rebecca Pifer • Feb. 12, 2025

A new, non-opioid pain drug is here. Getting it to patients could be agony.

After decades of research, Vertex Pharmaceuticals now has an approved pain medication. Can one of the world’s most powerful biotechs contend with a healthcare system that’s long favored opioids?

By Jacob Bell • Feb. 11, 2025

Humana’s 2024 profit slashed in half amid higher medical spending

The massive insurer now expects to lose 550,000 Medicare Advantage members — roughly one-tenth of its individual MA footprint — this year as a result of plan cuts.

By Rebecca Pifer • Feb. 11, 2025

Nearly two-thirds of Medicaid beneficiaries already work: KFF

Most adults on Medicaid are employed, suggesting few beneficiaries wouldn’t meet a work requirement policy being considered by Republicans in Congress.

By Emily Olsen • Feb. 7, 2025

Alphabet’s Verily to sell stop-loss insurance unit to Elevance

The deal could signal that Elevance wants to build out its commercial products to hedge against volatility in Medicaid and privatized Medicare plans.

By Rebecca Pifer • Feb. 7, 2025

Elon Musk’s DOGE gains access to CMS

The CMS said it’s working to find “opportunities for more effective and efficient use of resources in line with meeting the goals of President Trump.” The agency could be a big — and politically delicate — target for DOGE.

By Emily Olsen • Feb. 6, 2025

New contract wins ding Molina’s earnings outlook for 2025

Medicaid and dual-eligible contracts fuel growth for the California-based insurer, but also come with upfront implementation costs that will lower its earnings this year, executives said.

By Rebecca Pifer • Feb. 6, 2025

Express Scripts, Kroger reach new pharmacy network agreement

The two have mended fences after a nasty contract dispute in 2022 caused Kroger pharmacies to go out of network with Express Scripts’ members.

By Rebecca Pifer • Feb. 5, 2025

Oscar Health reports first profitable year

The insurer lost $153.5 million in the fourth quarter but still eked out a $25.4 million profit for the full year thanks to snowballing growth in ACA plans.

By Rebecca Pifer • Feb. 5, 2025

Molina closes ConnectiCare acquisition

The deal adds $1.4 billion in annual premiums to Molina’s topline and 140,000 additional Medicare, Affordable Care Act marketplace and commercial members to the insurer’s rolls.

By Rebecca Pifer • Feb. 4, 2025

Centene sets itself up for ‘equilibrium’ in 2025

The insurer also reported notable ACA growth for this year, though membership could tick back down through the second quarter due to program integrity efforts.

By Rebecca Pifer • Updated Feb. 5, 2025

Cigna to tie executive compensation to customer satisfaction

Cigna is one of a handful of national insurers that pledged to ameliorate customer pain points with healthcare, but the first to release a specific plan. 

By Rebecca Pifer • Feb. 3, 2025

ACA plans denied one-fifth of in-network claims in 2023, KFF finds

Insurers poked holes in KFF’s methodology — a spokesperson for UnitedHealth called the study “grossly misleading” — to argue that they approve most of the claims they receive.

By Rebecca Pifer • Jan. 31, 2025