Payer: Page 15
-
Joe Raedle/Getty Images via Getty Images
CMS to increase oversight on exchange brokers
The agency has reported a growing number of complaints about ACA health plan applications submitted by brokers.
By Emily Olsen • Oct. 7, 2024 -
Courtesy of UnitedHealth Group
UnitedHealth sues CMS over Medicare Advantage star ratings
A handful of plans owned by the nation's largest MA payer are the latest to ask the court to help raise their valuable quality scores.
By Rebecca Pifer • Oct. 4, 2024 -
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 -
Joe Raedle via Getty Images
Texas sues major PBMs, pharma companies over high insulin prices
The litigation comes as pharmacy benefit managers Express Scripts, CVS Caremark and Optum Rx face growing criticism over their role in high drug costs — including a recent lawsuit from the Federal Trade Commission.
By Emily Olsen • Oct. 4, 2024 -
Employers are focusing on plan designs to manage healthcare costs: survey
Nearly half of the employers surveyed said healthcare costs will exceed budget projections this year, WTW said.
By Ginger Christ • Oct. 3, 2024 -
Scott Olson via Getty Images
Medicare tweaks rules for second round of drug price talks
The agency will offer earlier meetings with drugmakers as well as solicit more patient feedback on the process.
By Ned Pagliarulo • Oct. 3, 2024 -
Spencer Platt via Getty Images
Humana’s Medicare Advantage dilemma worsens amid precipitous drop in 2025 star ratings
Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this year, the insurer disclosed last week. The downgrade could wipe out Humana’s profits in 2026.
By Rebecca Pifer • Oct. 3, 2024 -
Getty Images
Blue Shield of California sidesteps PBMs with new Humira biosimilar deal
It’s the first time this type of model has been used to bring a Humira biosimilar to market, according to the insurer — and it yields a much lower cost than both the brand-name version of the drug and its biologic copycats.
By Rebecca Pifer • Oct. 2, 2024 -
Mario Tama via Getty Images
CVS to lay off 2,900 employees amid reports of strategic review
CVS is cutting 1% of its workforce as the healthcare behemoth pursues a massive cost-cutting plan — and considers a potential breakup of its businesses, according to reports.
By Rebecca Pifer • Oct. 1, 2024 -
Getty Images
Top healthcare conferences to plan for in 2025
Here are notable events hospital, payer and tech executives should consider attending in the second half of the year, running the gamut from digital health to financial management to medical innovation.
By Sydney Halleman • Updated June 30, 2025 -
Mario Tama via Getty Images
J&J drops 340B rebate plan following government pressure
Threatened with steep sanctions and losing access to Medicare and Medicaid, Johnson & Johnson is rolling back a plan to give hospitals after-the-fact rebates for drugs in the 340B drug discount program.
By Rebecca Pifer • Oct. 1, 2024 -
Getty Images
MA premiums to decrease on average in 2025
The CMS said premiums, benefits and plan choices will hold steady in 2025, even as insurers have warned they could cut MA offerings in a bid to preserve profits.
By Emily Olsen • Sept. 30, 2024 -
Kent Nishimura / Stringer via Getty Images
Democrats introduce bill to make increased ACA subsidies permanent
If the enhanced tax credits expire, healthcare costs for millions of Americans will suddenly increase, and some could become uninsured, Democrats say. But Republicans argue the subsidies are costly and create opportunities for fraud.
By Rebecca Pifer , Emily Olsen • Sept. 26, 2024 -
Getty Images
Providers say claims denials are increasing: survey
Nearly three in four providers surveyed by Experian Health said the number of claims denied by payers shot up between 2022 and 2024.
By Susanna Vogel • Sept. 25, 2024 -
Courtesy of Food and Drug Administration
CMS holds accountable care organizations harmless for ‘highly suspect’ Medicare billing
Aberrant billing for urinary catheters last year could have made it harder for ACOs in Medicare to bring in shared savings. That’s no longer the case under a new final rule.
By Rebecca Pifer • Sept. 25, 2024 -
Chip Somodevilla via Getty Images
Novo CEO pressed by Senate to cut prices of obesity, diabetes drugs
CEO Lars Fruergaard Jørgensen told lawmakers the company would consider new talks with insurers about the list prices of Wegovy and Ozempic if they pledge to keep the medicines on their formularies.
By Jonathan Gardner • Sept. 25, 2024 -
Rebecca Pifer/Healthcare Dive
Epic hit with antitrust lawsuit by data startup Particle Health
Particle alleges electronic health record vendor Epic used its position as a “monopolist” to prevent competition in the payer market.
By Emily Olsen • Sept. 23, 2024 -
Getty Images
FTC sues major pharmacy benefit managers over insulin prices
The agency brought action against Caremark, Express Scripts and Optum Rx, arguing their “anticompetitive and unfair” rebating practices “artificially inflated” the list price of life-saving insulin drugs.
By Rebecca Pifer • Updated Sept. 20, 2024 -
Julia Rendleman via Getty Images
Cigna scaling back Medicare Advantage footprint in 8 states next year
The reductions will affect roughly 5,400 members, mostly in Florida, according to a notice to marketing agents.
By Rebecca Pifer • Sept. 20, 2024 -
Samuel Corum/Getty Images via Getty Images
Oak Street Health pays $60M to settle allegations of kickback scheme
Before the primary care chain was purchased by CVS Health, Oak Street illegally paid marketing agents for referring Medicare-eligible seniors to its clinics, according to the Department of Justice.
By Rebecca Pifer • Sept. 19, 2024 -
Anna Moneymaker via Getty Images
US is drastically behind other wealthy nations on healthcare, despite spending the most
The Commonwealth Fund analyzed the healthcare systems of 10 nations and found the U.S. ranked last in access to care, health outcomes and overall. The U.S. “really is in a class by itself,” one researcher said.
By Rebecca Pifer • Sept. 18, 2024 -
Mario Tama via Getty Images
J&J threatened with sanctions over plan to rebate 340B drugs
The HHS agency that oversees the 340B drug discount program is threatening Johnson & Johnson with steep fines — and loss of access to Medicare and Medicaid — if it stops giving hospitals upfront discounts.
By Rebecca Pifer • Sept. 18, 2024 -
Getty Images
Health benefit costs to rise 5.8% per employee in 2025: survey
About half of employers said they would make cost-cutting changes to their plans next year, like increasing deductibles or other cost-sharing provisions, according to a report from consultancy Mercer.
By Emily Olsen • Sept. 17, 2024 -
Getty Images
Express Scripts sues FTC over report damning pharmacy benefit managers
The major PBM said its lawsuit is necessary to protect against misinformation about the controversial drug middlemen, while the FTC promised to defend its research.
By Rebecca Pifer • Sept. 17, 2024 -
Getty Images
Medicare Advantage bonuses poised to drop this year for first time since 2015, KFF says
Still, plans are expected to rake in $11.8 billion in bonuses, with half of that tranche going to just two insurers: UnitedHealthcare and Humana.
By Rebecca Pifer • Sept. 13, 2024 -
Getty Images
Elevance to acquire Indiana University Health’s insurance business
IU Health Plans will operate under the Anthem Blue Cross and Blue Shield brand after the deal closes, which is expected at the end of 2024.
By Emily Olsen • Sept. 13, 2024
Previous
