Payer: Page 12
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Courtesy of UnitedHealth Group
UnitedHealth, Amedisys delay close date of $3.3B merger
The massive healthcare company and the home health provider have agreed to push back the timeline of their deal after the Department of Justice sued to block it.
By Rebecca Pifer • Jan. 7, 2025 -
Aetna sues drugmakers over alleged price-fixing scheme
The complaint alleges nearly two dozen pharmaceutical companies colluded to limit competition, causing costs for certain generic medications to skyrocket.
By Emily Olsen • Jan. 7, 2025 -
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 -
Yin Yang via Getty Images
Independent Health settles with Justice Department over alleged Medicare Advantage upcoding
The $100 million settlement is one of the larger recent sums agreed to by an MA payer accused of inflating its members’ sicknesses to get higher reimbursement from the government.
By Rebecca Pifer • Jan. 3, 2025 -
Kent Nishimura via Getty Images
Biden signs funding bill extending telehealth flexibilities, but no relief for doctors — or PBM reform
Physician groups slammed Congress for allowing a 2.8% cut to their Medicare pay to go into effect.
By Rebecca Pifer • Dec. 23, 2024 -
Win McNamee via Getty Images
Stopgap funding bill includes sweeping PBM reform, preserves telehealth flexibilities
The bipartisan agreement will fund the government through March. It could also reshape the pharmacy supply chain by reforming how controversial drug middlemen do business.
By Rebecca Pifer • Dec. 18, 2024 -
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GoodRx appoints former PBM exec as permanent CEO
Wendy Barnes will take up the role more than a year after the drug discount and digital health company’s founders stepped down as co-chief executives.
By Emily Olsen • Updated Dec. 19, 2024 -
Chip Somodevilla via Getty Images
Q&AFormer HHS Secretary Tom Price’s vision for the second Trump administration
President-elect Trump will likely resuscitate policies from his first term like Medicaid work requirements, Price said. The former HHS secretary also shared leadership advice for RFK Jr.: Appreciate the expertise of HHS staff.
By Rebecca Pifer • Dec. 17, 2024 -
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CMS says private Medicare plans can’t automatically deny Biogen’s ALS drug
In a rare move, the U.S. agency behind Medicare is warning Medicare Advantage providers they can’t have blanket policies that deny coverage of Qalsody because it’s “experimental and investigational.”
By Jacob Bell • Dec. 13, 2024 -
Rebecca Pifer/Healthcare Dive
Centene lobbies Trump administration to preserve Medicaid, ACA following ‘tragic’ year
The insurer warned Republicans about the political ramifications of cutting healthcare programs during its investor day, which began with a moment of silence for slain UnitedHealthcare CEO Brian Thompson.
By Rebecca Pifer • Dec. 13, 2024 -
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MedPAC supports add-on payments for low-income Medicare patient care
Commissioners on the Medicare Payment Advisory Commission also largely supported recommendations to increase pay for physicians and other health professionals slightly less than inflation in 2026.
By Emily Olsen • Dec. 13, 2024 -
Win McNamee via Getty Images
Democrats question Oz over Medicare Advantage advocacy, UnitedHealth stock
Lawmakers argued Mehmet Oz, who was nominated to oversee the CMS, has pushed to expand MA while owning stock in the largest MA plan provider, UnitedHealth.
By Emily Olsen • Dec. 12, 2024 -
Joe Raedle via Getty Images
Consumers who delayed choosing health insurance cite concerns with Trump administration: survey
About half of Americans say they’re worried about how the incoming administration could impact their health insurance, while 22% of people who put off choosing a plan cited the presidential turnover directly.
By Rebecca Pifer • Dec. 11, 2024 -
Mario Tama via Getty Images
New bipartisan legislation would force insurers, PBMs to sell pharmacy businesses
The PBM Act would make companies like CVS and UnitedHealth that own health insurers or PBMs sell pharmacy assets. That would help independent pharmacies, but may not help patients, according to one expert.
By Rebecca Pifer • Dec. 11, 2024 -
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FTC warns 21 healthcare marketers against deceptive claims
The warnings come less than a week after the fatal shooting of a UnitedHealthcare CEO unleashed expressions of anger on social media about health insurer practices.
By Maura Webber Sadovi • Dec. 10, 2024 -
Joe Raedle via Getty Images
Premiums could rise, millions could lose coverage if enhanced ACA subsidies expire: CBO
The number of uninsured Americans will increase by 3.8 million on average each year from 2026 to 2034 if the subsidies lapse, according to an estimate by the Congressional Budget Office.
By Emily Olsen • Dec. 10, 2024 -
Spencer Platt via Getty Images
Health insurers remove executive bios, images from websites after UnitedHealthcare CEO killing
UnitedHealth, Elevance and some BCBS plans have deleted senior leadership pages from their corporate sites, while Centene and CVS scrubbed images of their executives online.
By Rebecca Pifer • Dec. 6, 2024 -
Permission granted by Elevance Health
Elevance cancels plan to cap anesthesia coverage for surgeries
The insurer’s Anthem Blue Cross Blue Shield subsidiary is pulling the controversial policy, citing “significant widespread misinformation.”
By Rebecca Pifer • Dec. 5, 2024 -
Stephen Maturen via Getty Images
Industry condolences, social media vitriol follow UnitedHealthcare CEO’s killing
Brian Thompson’s death set off a flood of darkly celebratory social media posts offset by solemn remembrances from his peers and other healthcare leaders.
By Rebecca Pifer • Dec. 5, 2024 -
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About 1 in 3 retail pharmacies have closed since 2010: study
Independent pharmacies were more likely to shut down, possibly because they’re more often excluded from pharmacy benefit managers’ networks, according to research published in Health Affairs.
By Emily Olsen • Dec. 4, 2024 -
Courtesy of UnitedHealth Group
UnitedHealthcare CEO Brian Thompson fatally shot in NYC
The NYPD confirmed the shooting, which cut UnitedHealth’s investor conference short on Wednesday morning. The company said it is “deeply saddened and shocked” by Thompson’s passing.
By Rebecca Pifer • Updated Dec. 4, 2024 -
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CMS recalculates Medicare Advantage stars for UnitedHealth, Centene
After both insurers challenged the agency in court, the CMS improved scores for 12 UnitedHealth contracts and seven Centene contracts.
By Rebecca Pifer • Dec. 4, 2024 -
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Humana CFO Susan Diamond to step down
Celeste Mellet, currently the finance chief at an infrastructure investment fund, will take on the insurer’s CFO role in early January.
By Emily Olsen • Dec. 3, 2024 -
Joey Sirmons / Healthcare Dive/Healthcare Dive
8 experts on leveraging AI in healthcare
Healthcare organizations must carefully vet AI tools, address patient concerns and keep an eye on standards and regulation, according to industry experts who spoke at a Healthcare Dive virtual event.
By Sydney Halleman • Dec. 3, 2024 -
The best photo for all/istockphoto.com
Sponsored by VeradigmTransforming payer operations through real-time clinical data exchange
Discover how real-time clinical data exchange enhances payer operations, care quality and efficiency.
Dec. 2, 2024 -
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Nearly a quarter of Americans are underinsured: report
Twenty-three percent of working-age adults with health insurance face high out-of-pocket costs that make it difficult to afford care, according to a survey by the Commonwealth Fund.
By Emily Olsen • Nov. 27, 2024
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