Dr. Oz confirmed to lead CMS

Dr. Mehmet Oz, a physician and TV personality, will lead the agency during a turbulent time for federal health programs as the HHS lays off thousands of staffers and Republicans float potential cuts to Medicaid.

By Emily Olsen • Updated April 4, 2025

FTC pauses PBM litigation in win for Caremark, Express Scripts, Optum Rx

The FTC says it doesn’t have enough active commissioners to move forward after President Donald Trump fired two Democrats last month.

By Rebecca Pifer Parduhn • April 3, 2025

ACA enrollment increase driven by growth in states won by Trump: KFF

Sign-ups for coverage on the Affordable Care Act exchanges have more than doubled since 2020. Enrollment was particularly concentrated in states won by President Donald Trump in last year’s election.

By Emily Olsen • April 2, 2025

Advocacy groups say Medicaid cuts would be ‘catastrophic’

In a letter to Senate Majority Leader John Thune, hundreds of groups said the potential cuts would “shred our nation’s social safety net,” delaying access to care and ultimately driving up healthcare costs.

By Emily Olsen • March 28, 2025

DOJ backs up providers in suit against Claritev

Claritev, formerly known as MultiPlan, is being accused of conspiring with insurers to lower reimbursement for providers. The DOJ agrees, filing a statement of interest in the consolidated suit against the cost management firm.

By Rebecca Pifer Parduhn • March 26, 2025

Senate committee advances Dr. Oz to lead CMS

Democrats on the Senate Finance Committee criticized the physician and TV personality ahead of the vote Tuesday for avoiding questions about potential cuts to Medicaid.

By Emily Olsen • March 26, 2025

Judge dismisses lawsuit against Wells Fargo over prescription drug costs

The decision could throw cold water on potential copycat suits seeking to hold large, self-funded employers responsible if they overpay for prescription drugs.

By Rebecca Pifer Parduhn • March 26, 2025

Medicaid, SNAP cuts could lead to 1 million jobs lost in 2026: report

Reducing spending on Medicaid and the food assistance program could batter state economies and lead to job cuts — including 477,000 roles in in the healthcare sector alone, according to the Commonwealth Fund.

By Emily Olsen • March 25, 2025

GLP-1s are accelerating spending growth on traditional drugs, Evernorth research finds

Spending growth for simple medications used to treat common health problems is outstripping spending growth for pricey medications used to treat complex and chronic conditions, according to a new report from a Cigna subsidiary.

By Rebecca Pifer Parduhn • Updated March 25, 2025

Optum Rx is reforming how it pays pharmacies

The massive PBM is pivoting to a cost-based reimbursement model, which it says will reduce variation in how pharmacies are paid. Pharmacy groups say that depends on the specifics of Optum Rx’s plan.

By Rebecca Pifer Parduhn • March 21, 2025

Cigna closes $3.7B sale of Medicare business to HCSC

The deal, which removes Cigna from the volatile Medicare Advantage market, closed a little over a year after being announced.

By Rebecca Pifer Parduhn • March 20, 2025

Medicaid work requirements could cut coverage for 5.2M

A new report found that millions could lose access to care, even though most Medicaid beneficiaries are working or should be eligible for exemptions from work requirements.

By Susanna Vogel • Updated March 24, 2025

Jefferson Health goes out of network for Cigna commercial members following contract spat

The Philadelphia-area system and major insurer have failed to reach a new agreement on payment rates, but are still continuing negotiations.

By Rebecca Pifer Parduhn • March 19, 2025

Optum Rx says it will eliminate 10% of prior authorizations

The massive pharmacy benefit manager plans to stop requiring coverage reauthorizations for roughly 80 drugs used to treat migraines, multiple sclerosis, high cholesterol and more.

By Rebecca Pifer Parduhn • March 19, 2025

Dr. Oz vows to scrutinize Medicare Advantage as CMS head

Mehmet Oz, who previously advocated for expanding the privatized Medicare program, said he would tackle upcoding among MA plans if confirmed.

By Emily Olsen • March 17, 2025

CMS nominee Dr. Oz says he supports Medicaid work requirements

Republicans are considering tying eligibility in the safety-net program to work, volunteer or education hours to meet spending targets.

By Emily Olsen • March 14, 2025

Nevada announces intent to award Medicaid contracts

The Silver State plans to award managed care contracts to newcomer CareSource and incumbents UnitedHealth, Elevance, Centene and Molina.

By Rebecca Pifer Parduhn • March 14, 2025

CMMI cancels 4 payment models early

The CMS estimates terminating the models will save nearly $750 million. The agency will also no longer implement two demonstrations that aimed to improve prescription drug affordability and access.

By Emily Olsen • March 13, 2025

Cigna reshuffles C-suite amid rising costs

Cigna promoted Brian Evanko to chief operating officer and named a new chief financial officer in his place, while Eric Palmer will be leaving the company as an apparent victim of the restructuring.

By Rebecca Pifer Parduhn • March 13, 2025

Medicaid expansion cuts could hit provider revenue, spike uncompensated care: report

If states end their expansion programs in response to funding cuts, spending on healthcare services would fall by nearly $80 billion and uncompensated care costs would rise by $19 billion in 2026, according to new research.

By Emily Olsen • March 12, 2025

Trump administration proposes ACA program integrity rule that would decimate enrollment

The rule is like “making people crawl through broken glass” for health insurance, one expert said.

By Rebecca Pifer Parduhn • March 11, 2025

Republicans can’t meet budget target without Medicaid cuts: CBO

Excluding large health insurance programs, spending under the House Energy and Commerce Committee's purview falls far short of the budget blueprint’s $880 billion goal for cuts.

By Emily Olsen • March 10, 2025

Vertex’s new pain drug gets first coverage nod from major insurer

Optum Rx, the pharmacy benefit manager owned by UnitedHealth Group, placed Journavx on some of its commercial formularies in an interim decision while a formal review continues.

By Jacob Bell • March 6, 2025

EHR vendors turn to artificial intelligence to modernize health records

Software companies like Epic and Oracle say they’re weaving AI into clinicians’ workflows to meet client demand, keep up with competitors and improve the productivity of a swamped healthcare system.

By Rebecca Pifer Parduhn • March 6, 2025

Older, self-employed enrollees more likely to lose ACA subsidies if enhanced tax credits lapse: KFF

Beneficiaries who earn more than four times the federal poverty level wouldn’t be eligible for any subsidies on marketplace plans if the enhanced premium tax credits expire at the end of the year.

By Emily Olsen • March 5, 2025