Payer: Page 2


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    Boston Scientific, MDMA call for more transparency, oversight of Medicare Advantage plans

    Privately offered Medicare Advantage plans “do not often provide a clear reason for the denial of coverage, and rarely offer any visibility into the evidence and methodology,” trade group MDMA and Boston Scientific said.

    By Nick Paul Taylor • Feb. 15, 2023
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    Alex Wong via Getty Images

    CMS plans trio of experiments aimed at lowering drug costs

    The pilot programs could allow adjusted payments for drugs cleared under accelerated approval and help states manage the costs of gene therapies.

    By Christopher Newman • Feb. 15, 2023
  • Trendline

    Social determinants of health

    The focus on social determinants of health has only increased as the COVID-19 pandemic has devastated the United States.

    By Healthcare Dive staff
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    Illustration: Xavier Lalanne-Tauzia for Industry Dive

    Elevance Health closes deal to acquire BioPlus

    BioPlus will now operate as a part of the insurer’s pharmacy benefit manager, CarelonRx.

    By Feb. 15, 2023
  • Surgical procedures cost significantly more at hospitals in networks versus independent facilities, study finds

    The median price for a shoulder arthroscopy was $4,432 at hospitals within a network, compared to $2,643 at independent hospitals, new research in JAMA Network Open found.

    By Feb. 14, 2023
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    Fotolia
    Surprise Billing

    HHS pauses surprise billing arbitration after Texas court decision

    The process by which health insurers and medical providers hash out payments for surprise bills is still in flux due to a series of lawsuits threatening the dispute resolution process.

    By Feb. 13, 2023
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    Drew Angerer / Staff via Getty Images

    HHS readies for PHE wind down, end of pandemic flexibilities

    A variety of pandemic-era policies will expire May 11, including those allowing providers to prescribe controlled substances via telehealth without an in-person visit and rules requiring payers to cover COVID-19 testing.

    By Feb. 10, 2023
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    Jacob Bell/Healthcare Dive
    Opinion

    Tipping point is in sight: Value-based care is driving meaningful financial results

    Strata’s Liz Kirk shares her reflections on value-based care based on the 41st annual J.P. Morgan Healthcare Conference held in San Francisco.

    By Liz Kirk • Feb. 10, 2023
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    Illustration: Xavier Lalanne-Tauzia for Industry Dive

    Molina expects contract wins to offset Medicaid losses

    The forecast comes as its competitor, Centene, expects to lose as many as 2.2 million Medicaid members when pandemic protections end and states resume eligibility checks.

    By Feb. 9, 2023
  • Centene's headquarters in Clayton, Missouri, a suburb outside of St. Louis.
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    Samantha Liss for Healthcare Dive

    Centene reaches $215M settlement with California

    This latest settlement is the largest the payer has reached so far regarding state overcharging allegations.

    By Feb. 9, 2023
  • Centene's headquarters in Clayton, Missouri, a suburb outside of St. Louis.
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    Samantha Liss for Healthcare Dive

    Centene set to lose 2M Medicaid members as pandemic protections end

    The insurer said it expects to add some members who are no longer eligible for Medicaid to its ACA exchange plans.

    By Feb. 8, 2023
  • A photograph of a box of Amylyx Pharmaceuticals' ALS medicine Relyvrio
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    Permission granted by Amylyx Pharmaceuticals

    Cigna restricts coverage of new ALS drug, deepening fears about access

    The health insurer’s national formulary considers Amylyx Pharmaceuticals’ Relyvrio to be "experimental, investigational or unproven for any use,” and now does not recommend covering it.

    By Jacob Bell • Feb. 8, 2023
  • U.S. President Joe Biden delivers his State of the Union address during a joint meeting of Congress in the House Chamber of the U.S. Capitol on February 07, 2023 in Washington, DC.
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    Chip Somodevilla via Getty Images

    Biden zeroes in on drug costs during State of the Union address

    The president called for extending Medicare's $35 insulin price cap to all Americans and blasted “big pharma” for record profits while at the same time “unfairly charging people hundreds of dollars.”

    By Feb. 8, 2023
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    ipopba via Getty Images

    Top healthcare trends of 2023

    Providers and payers are still grappling with the fallout from the COVID-19 pandemic, including the winding down of pandemic-era policies, which will have major effects on hospitals and insurers.

    By Feb. 8, 2023
  • A brick wall with a red CVS Pharmacy sign.
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    Justin Sullivan via Getty Images

    CVS, Oak Street stump for $10.6B combination by outlining plans for growth

    Linking Oak Street with CVS assets could drive new patients to Oak Street. It could also help Aetna retain more MA members and drive greater use of CVS’ pharmacy and PBM, management said Wednesday.

    By Feb. 8, 2023
  • A view from below of the CVS sign on the center of a building, with a vertical blue HealthHub sign to its right.
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    Mario Tama via Getty Images

    CVS buys Oak Street Health for $10.6B

    The acquisition is a major development in the strategic positioning of large retailers in the primary care space, analysts said.

    By Feb. 8, 2023
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    Fotolia
    Surprise Billing

    Judge’s ruling on surprise billing threatens to disrupt arbitration process

    The ruling tosses out portions of a final rule and raises questions about the arbitration process providers and payers are currently using to resolve payment disputes related to out-of-network care.

    By Feb. 7, 2023
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    dventtr via Getty Images

    MA enrollment grew 337% from 2006 through 2022, study finds

    Traditional Medicare lost 1 million enrollees over the same period, according to new research published in Health Affairs.

    By Feb. 7, 2023
  • A picture of the exterior of a CVS Pharmacy with the logo and name in view.
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    Bruce Bennett via Getty Images

    CVS taps new chief diversity, equity and inclusion officer

    Shari Slate will lead the company’s strategy concerning its diversity and community initiatives.

    By Feb. 6, 2023
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    Scott Eisen via Getty Images

    Cigna addresses MA overhaul, fresh off $6.7B in profit

    CEO David Cordani discussed the CMS’ recent changes to the Medicare Advantage program, Cigna’s multibillion-dollar investment in VillageMD and more in the payer’s fourth-quarter earnings call on Friday.

    By Feb. 3, 2023
  • More patients — especially younger ones — are switching providers, survey finds

    About 30% of patients selected a new provider in 2021, up from 26% in 2017, according to a new report from Accenture. Gen Zers and millennials were six times more likely to switch providers than older people.

    By Feb. 2, 2023
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    CMS

    CMS issues 2% MA rate hike for 2024

    Trade association AHIP said it was “concerned with the potential adverse impact of the rate notice,” especially in light of other recent regulation seeking to claw back overpayments to MA payers.

    By Feb. 2, 2023
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    Vladimir Vladimirov/Getty Images via Getty Images
    Surprise Billing

    Texas Medical Association files fourth suit challenging surprise billing ban

    The latest lawsuit focuses on boosted fees that both parties must pay for arbitration to solve billing disputes between providers and payers.

    By Feb. 1, 2023
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    Illustration: Xavier Lalanne-Tauzia for Industry Dive

    Humana expects 14% hike in 2023 MA enrollment as it taps new leaders

    The payer said it expects to pick up 625,000 individual Medicare Advantage members in 2023.

    By Feb. 1, 2023
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    dventtr via Getty Images

    CMS to crack down on Medicare Advantage audits, poised to claw back billions of dollars from insurers

    Federal regulators have raised concerns about alleged payment abuses in the MA program for years, specifically for those tied to risk adjustments. 

    By Jan. 31, 2023
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    Insurance lobby blasts Medicare Advantage audit rule

    The America’s Health Insurance Plans lobby said the rule seeking to claw back billions of dollars from health insurers is unlawful and fatally flawed. 

    By Jan. 31, 2023