Payer: Page 11
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Medicare Part D premiums likely to increase next year
The average monthly bid submitted by insurers for 2026 prescription drug plans increased 33% from last year, according to data released by the CMS.
By Emily Olsen • July 30, 2025 -
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Judge halts Arkansas law forcing PBMs to sell pharmacies
U.S. District Judge Brian Miller agreed with pharmacy benefit managers that the state’s law may violate the Constitution in granting their request for a preliminary injunction.
By Rebecca Pifer Parduhn • July 30, 2025 -
Permission granted by Elevance Health
Elevance names former Cencora CEO to board
Steve Collis’ three decades of experience at a major drug distributor could prove helpful for Elevance as it continues to build out its pharmacy services.
By Rebecca Pifer Parduhn • July 30, 2025 -
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Humana hikes 2025 guidance on medical cost control, pharmacy growth
The health insurer’s results are a bright spot in what’s otherwise been a gloomy quarter for the sector. Humana says it has a handle on snowballing medical costs after taking a conservative stance heading into the year.
By Rebecca Pifer Parduhn • July 30, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth expects lower profits in 2025 amid medical cost spike
The beleaguered company plans to focus on business fundamentals, cut Medicare Advantage plans, raise prices and forge a new relationship with regulators as it slogs its way back to favored status with Wall Street.
By Rebecca Pifer Parduhn • July 29, 2025 -
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OpinionDrug innovation should benefit patients. PBMs are preventing that from happening.
Health plans should directly contract with drug manufacturers to provide medications at transparent and affordable prices, argues Kathy Chang, head of trade relations at Blue Shield of California.
By Kathy Chang • July 29, 2025 -
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Top medical association warns RFK Jr. not to overhaul preventive services task force
The health secretary reportedly wants to fire all 16 members of the task force that advises insurers on what services they have to cover under the Affordable Care Act. The American Medical Association thinks that’s a bad idea.
By Rebecca Pifer Parduhn • July 28, 2025 -
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Centene stock hits decade low after insurer reports rare loss on higher medical costs
The St. Louis-based payer slipped into the red during the second quarter for the first time since 2022. Centene executives said they were disappointed and frustrated by the results.
By Rebecca Pifer Parduhn • July 25, 2025 -
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UnitedHealth confirms it’s under investigation by DOJ
The company said it was complying with criminal and civil investigations from the Justice Department into its Medicare program.
By Sydney Halleman • July 24, 2025 -
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Molina cuts 2025 earnings outlook again on ACA, Medicaid pressures
The California-based insurer outlined its plans to survive what CEO Joe Zubretsky deemed a “season of great uncertainty” stemming from roiling acuity shifts and looming policy changes.
By Rebecca Pifer Parduhn • July 24, 2025 -
Rebecca Pifer/Healthcare Dive
A ‘bastardized’ program: GOP lawmakers eye Medicare Advantage reform
In a hearing this week, Republican legislators appeared open to changing the privatized Medicare program — once a GOP darling that’s fallen out of favor amid concerns about prior authorizations, care denials and profiteering.
By Rebecca Pifer Parduhn • July 23, 2025 -
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Half of large employers plan to shift health plan costs onto employees: Mercer
Employers are looking for ways to manage costs, cover popular weight loss drugs and offer well-being and mental health options.
By Carolyn Crist • July 23, 2025 -
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10M people will lose insurance due to GOP policy law: CBO
The final tally from the nonpartisan budget scorekeeper estimates the law will decrease federal healthcare spending by $1.1 trillion over the next decade.
By Emily Olsen • July 23, 2025 -
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ACA health plan premiums could spike in 2026: report
Insurers are requesting a median premium increase of 15% for 2026 as they grapple with policy uncertainty for plans on the exchanges, according to an analysis from KFF and the Peterson Center on Healthcare.
By Emily Olsen • July 22, 2025 -
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Humana refiles Medicare Advantage star ratings suit
Humana is taking a second bite at the apple to improve its sunken MA stars, filing an edited complaint with a Texas court on Monday. The insurer also announced plans to pare back its prior authorization policies.
By Rebecca Pifer Parduhn • July 22, 2025 -
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States sue Trump administration over ACA eligibility, enrollment rule
The lawsuit argues the rule would drive up the number of uninsured and saddle states with increased healthcare expenses.
By Emily Olsen • July 21, 2025 -
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Sponsored by VeradigmThe next evolution of provider engagement: Why workflow integration matters
Discover how workflow integration is reshaping provider engagement and improving patient outcomes.
By Veradigm • July 21, 2025 -
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Civil monetary penalties against Medicare Advantage, Medicare drug plans rising, CMS data shows
Civil monetary penalties against payers for improperly delaying or denying coverage, hitting members with higher cost sharing than allowed and other issues have already surpassed $3 million this year.
By Rebecca Pifer Parduhn • July 18, 2025 -
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Judge dismisses Humana’s Medicare Advantage star ratings suit
It’s a significant loss for the insurer, which sued the government late last year after its star ratings plummeted for 2025. Analysts estimate Humana could lose billions of dollars as a result of the decision.
By Rebecca Pifer Parduhn • Updated July 18, 2025 -
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Trump administration to end Medicaid waivers for continuous enrollment, workforce training
On Thursday, CMS sent letters to states notifying them that it doesn’t plan to approve any new such waivers or extend existing ones in the administration’s latest curtailing of Medicaid.
By Rebecca Pifer Parduhn • July 18, 2025 -
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Elevance cuts 2025 guidance as profit falls from higher ACA, Medicaid costs
The insurer attempted to reassure investors that it can operate through looming policy changes that appear set to worsen existing challenges. It was unsuccessful: Elevance’s stock fell 11% following the second quarter results.
By Rebecca Pifer Parduhn • July 17, 2025 -
Ned Pagliarulo/Healthcare Dive
33 states pick up CMS program to pay for sickle cell gene therapies
States representing about 84% of Medicaid beneficiaries are participating in an initiative that enables the government to negotiate pay-for-performance deals with the manufacturers of products like Casgevy and Lyfgenia.
By Ben Fidler • July 16, 2025 -
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Medicaid cuts could have ‘far-reaching’ healthcare, economic impacts: study
Coverage losses linked to the massive tax and policy law could drive up excess deaths and preventable hospitalizations by 2034, according to the study in JAMA Health Forum.
By Emily Olsen • July 16, 2025 -
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CVS beats out UnitedHealth for CalPERS pharmacy benefits contract
The contract, though sizable, is likely immaterial to CVS’ earnings. But it moves the company in a positive direction as it struggles with recent challenges, an analyst said.
By Rebecca Pifer Parduhn • July 16, 2025 -
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Medicare targets site neutrality, price transparency in hospital outpatient rule
The proposed rule would send an additional $8 billion to hospitals next year, but includes a number of other policies hospital groups have criticized.
By Sydney Halleman , Emily Olsen • July 16, 2025
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