Payer: Page 22
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CVS replaces CEO Karen Lynch with Caremark head
The struggling healthcare giant also pulled its earnings guidance, citing increased medical cost pressures in health benefits.
By Emily Olsen • Oct. 18, 2024 -
Permission granted by Elevance Health
Elevance lowers guidance on ‘unprecedented’ Medicaid challenges
Executives said the increased costs pressuring its Medicaid business would improve after states updated payment rates to better match member acuity.
By Emily Olsen • Oct. 17, 2024 -
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Blue Cross Blue Shield to pay $2.8B to settle class action provider antitrust case
It's the largest antitrust settlement to date in the healthcare industry, according to law firm Whatley Kallas, which represented the plaintiffs.
By Susanna Vogel • Updated Aug. 22, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth lowers adjusted profit outlook as cyberattack costs rise
The insurer has recorded $2.5 billion in total impacts from the attack through the nine months ended Sept. 30, according to UnitedHealth’s third-quarter earnings.
By Emily Olsen • Oct. 15, 2024 -
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Medicare Advantage star ratings fall again in 2025
About 40% of MA plans with prescription drug coverage will earn four or more stars, a dip from 42% this year, according to data released by the CMS.
By Emily Olsen • Oct. 11, 2024 -
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Fewer than 1 in 5 employer-sponsored plans cover GLP-1s for weight loss
While employers footed the bill for health plan price increases in 2024, they were largely unwilling to give employees access to popular weight loss drugs.
By Susanna Vogel • Oct. 10, 2024 -
Chip Somodevilla via Getty Images
UnitedHealth, CVS push to remove FTC Chair Lina Khan from PBM case
Attorneys argue Khan and two other commissioners are biased against pharmacy benefit managers and should recuse themselves from an ongoing lawsuit against the middlemen.
By Emily Olsen • Oct. 10, 2024 -
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Centene completes sale of management services subsidiary
The sale of Collaborative Health Systems to value-based care firm Astrana Health comes after Centene has divested a number of non-core assets in recent years.
By Emily Olsen • Oct. 9, 2024 -
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 Parduhn • Oct. 4, 2024 -
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 -
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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 Parduhn • Oct. 3, 2024 -
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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 Parduhn • 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 Parduhn • Oct. 1, 2024 -
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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 Parduhn • Oct. 1, 2024 -
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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 Parduhn , Emily Olsen • Sept. 26, 2024 -
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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 Parduhn • 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 -
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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 Parduhn • Updated Sept. 20, 2024
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