Payer: Page 2


  • Cigna's logo is seen on a door.
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    Deep Dive

    Why Cigna is capping cost increases for pricey GLP-1 weight loss drugs

    The move — the first of its kind — comes as pharmacy benefit managers continue to try to prove their value to clients, and shows how major players are shoring up to meet sky-high GLP-1 demand.

    By March 8, 2024
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    Courtesy of UnitedHealth Group
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    Change Healthcare cyberattack

    Change says its largest claims clearinghouses coming back online

    More than $14 billion in claims have been prepared for processing and will start flowing soon, the technology firm said Friday.

    By Updated March 25, 2024
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    RossHelen via Getty Images
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    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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    Joe Raedle via Getty Images
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    Biden proposes strengthening Medicare’s drug pricing power

    The administration seeks to significantly increase the number of drugs each year that would be subjected to price negotiations under provisions of the Inflation Reduction Act. 

    By Kristin Jensen • March 7, 2024
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    FG Trade via Getty Images
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    Medicare Advantage beneficiaries receive fewer home health visits, study finds

    Medicare Advantage beneficiaries were also less likely to improve self-care and mobility function, according to research published in JAMA Health Forum.

    By March 5, 2024
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    Elevance gains $190M on revised MA star ratings

    It’s a positive development for the insurer, which sued the government earlier this year after its quality scores fell dramatically.

    By March 5, 2024
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    George Frey / Getty Images Plus via Getty Images
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    Change Healthcare cyberattack

    AlphV’s hit on Change Healthcare strikes a sour note for defenders

    The ransomware group didn’t just regroup quickly after a law enforcement takedown. It carried out the worst attack on U.S. infrastructure to date, according to experts.

    By Matt Kapko • March 4, 2024
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    Kameleon007 via Getty Images
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    Molina loses Medicaid contract in Virginia

    It’s the second recent Medicaid state loss for Molina, despite executives expressing confidence about the insurer’s ability to retain contracts.

    By March 1, 2024
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    Permission granted by Elevance Health
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    Elevance launches weight management program, including GLP-1 monitoring

    Elevance joins a growing list of insurers expanding their weight management offerings amid soaring demand for GLP-1 drugs.

    By Feb. 28, 2024
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    Courtesy of UnitedHealth Group
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    UnitedHealth under antitrust investigation by DOJ: reports

    Regulators are reportedly looking into the massive healthcare conglomerate’s potential anticompetitive effects, including the relationship between its health insurer UnitedHealthcare and physician network Optum.

    By Feb. 28, 2024
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    Alex Wong via Getty Images
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    Lobby-funded study argues Medicare Advantage rate cuts are worse than CMS expects

    Medicare Advantage payment per month per beneficiary could drop by 1% next year if regulators finalize rates as proposed, according to the analysis backed by the Better Medicare Alliance.

    By Feb. 27, 2024
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    Colin Campbell/Healthcare Dive
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    State attorneys general urge PBM reform

    The letter, sent on behalf of 39 state attorneys general to leaders in Congress, comes as lawmakers consider legislation to regulate the pharmacy middlemen.

    By Feb. 23, 2024
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    Adene Sanchez via Getty Images
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    Medicare Advantage plans provide less intensive post-acute care, study finds

    The research found no differences in 30-day hospital readmissions or mortality, but the study’s authors said more analysis on patients’ long-term functioning was needed.

    By Feb. 21, 2024
  • A picture of the exterior of the US Department of Health and Human Services. In front of the building is a black sign designating the building's name.
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    Alex Wong via Getty Images
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    CMS finalizes rule to cut Medicaid DSH payments for some hospitals

    Under the new definition, hospitals can only receive disproportionate share hospital Medicaid reimbursements for beneficiaries who are primarily insured by the safety-net program.

    By Updated Feb. 22, 2024
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    Gerenme via Getty Images
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    No Surprises implementation created uptick in in-network claims: Fair Health

    From the fourth quarter of 2021 to the first quarter of 2022, in-network care as a percentage of all national claim lines increased 2.3%, the nonprofit found.

    By Feb. 20, 2024
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    Sensay via Getty Images
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    Deep Dive

    Insurers brace for continued Medicare Advantage medical costs

    The big question coming out of the health insurance earnings season is how much elevated utilization among seniors is carrying over into 2024.

    By Feb. 20, 2024
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    erdikocak via Getty Images
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    Disputes over surprise billing continue to soar, new CMS data shows

    Arbiters are mostly selecting the higher payment offer in billing dispute determinations. That suggests No Surprises could actually raise premiums for consumers, one health researcher said.

    By Feb. 16, 2024
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    CFO Editorial Staff
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    SCAN Group, CareOregon abandon merger plans

    The insurers have dissolved their merger a little over a year after it was announced amid rising criticism from politicians and the public. 

    By Feb. 15, 2024
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    Blue Cross of Louisiana halts sale to Elevance

    It's the latest setback for the $2.5 billion deal, which was proposed early last year but has struggled to close amid a lack of buy-in from state regulators. 

    By Feb. 15, 2024
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    erdikocak via Getty Images
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    Private equity deals in Medicare Advantage decline, report finds

    High interest rates and new regulations could be driving the slowdown, according to a report by the Private Equity Stakeholder Project. 

    By Feb. 14, 2024
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    Stock via Getty Images
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    Humana sued over alleged 340B underpayments in Medicare Advantage

    Alabama-based Baptist Health argued the insurer had received a “windfall” due to illegal payment cuts in the 340B drug discount program.

    By Feb. 13, 2024
  • Elevance headquarters is a large white and brown building surrounding a grassy quad.
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    Elevance lays off more employees

    The health insurer has quietly laid off thousands of employees since September, according to sources.

    By Feb. 13, 2024
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    RiverNorthPhotography via Getty Images
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    FTC obtains $195M judgment against Simple Health for selling ‘sham’ insurance

    The Florida-based insurer deceived tens of thousands of consumers into purchasing what they believed was comprehensive coverage, but instead amounted to a medical discount membership.

    By Feb. 12, 2024
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    hapabapa via Getty Images
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    Molina’s redeterminations losses reach 500K members

    As for Medicare Advantage, the insurer said it expects proposed 2025 rates other payers have slammed as a cut would actually boost its benchmark rate.

    By Feb. 8, 2024
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    Courtesy of UnitedHealth Group
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    UnitedHealth COO Dirk McMahon to retire

    McMahon is leaving after two decades at the insurer.

    By Feb. 8, 2024
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    Justin Sullivan via Getty Images
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    CVS cuts 2024 outlook on Medicare Advantage caution

    The insurer on Wednesday joined its peers in slamming proposed MA payment rates as insufficient given the dogged increase in medical costs.

    By Feb. 7, 2024