Payer: Page 23
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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 Parduhn • Sept. 20, 2024 -
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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 Parduhn • Sept. 19, 2024 -
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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 Parduhn • Sept. 18, 2024 -
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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 Parduhn • Sept. 18, 2024 -
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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 -
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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 Parduhn • Sept. 17, 2024 -
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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 Parduhn • Sept. 13, 2024 -
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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 -
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PBM executives decline to revise controversial testimony to House committee
The leaders of Caremark, Optum Rx and Express Scripts had until last week to walk back statements they made in July — or face potential legal action. However, the executives are sticking to their guns.
By Rebecca Pifer Parduhn • Sept. 12, 2024 -
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Major PBMs could be zeroing in on specific payer markets for dominance, study suggests
Though CVS Caremark holds a dominant share of the commercial, Medicare Part D and Medicaid managed care markets, each large pharmacy benefit manager seems to be focusing on one particular arena.
By Rebecca Pifer Parduhn • Sept. 11, 2024 -
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Iowa awards Centene Medicaid managed care contract
Iowa Total Care, a subsidiary of the St. Louis-based payer, can continue doing business in Iowa’s managed care program, which paid it $2.8 billion in the last fiscal year.
By Rebecca Pifer Parduhn • Sept. 10, 2024 -
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Biden administration finalizes rule raising mental health coverage standards for private plans
The rule gives additional teeth to an almost 16-year-old law meant to force health insurers to cover mental health and substance use benefits at the same level as physical healthcare.
By Rebecca Pifer Parduhn • Sept. 10, 2024 -
Permission granted by Elevance Health
Elevance expands ACA plans in Florida, Texas, Maryland
The insurer’s Wellpoint subsidiary is expanding its ACA footprint for the 2025 coverage year, likely in a bid to capture enrollees who recently lost Medicaid coverage.
By Rebecca Pifer Parduhn • Sept. 9, 2024 -
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Mississippi awards Medicaid contracts to Centene, Molina, TrueCare
The Magnolia State has finally issued new contracts for its Medicaid managed care program, two years later than intended after UnitedHealth and Elevance challenged the awards following unsuccessful bids.
By Rebecca Pifer Parduhn • Sept. 5, 2024 -
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Molina puts CFO in charge of Medicaid, ACA marketplace businesses
Chief financial officer Mark Keim is taking the reins of the health insurer’s bread-and-butter business — Medicaid — along with a growing marketplace division.
By Rebecca Pifer Parduhn • Sept. 4, 2024 -
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Drug distributors agree to $300M settlement for role in opioid epidemic
The settlement adds to the billions of dollars that McKesson, Cencora and Cardinal have already agreed to pay in restitution for flooding the U.S. with highly addictive painkillers.
By Rebecca Pifer Parduhn • Sept. 4, 2024 -
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PBM executives threatened with fines and jail time for alleged perjury in House hearing
Testimony from the heads of Express Scripts, Optum Rx and Caremark in July defending pharmacy benefit managers’ business practices could be coming back to bite them.
By Rebecca Pifer Parduhn • Aug. 29, 2024 -
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Surprise BillingMore than one-fifth of insurers failed to pay No Surprises awards last year, provider lobby says
The advocacy group comprised of physician firms like TeamHealth and Envision has issued the provider industry’s latest salvo against insurers over surprise billing.
By Rebecca Pifer Parduhn • Aug. 28, 2024 -
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Fertility benefits are on the rise: report
More employers now offer fertility benefits, particularly fertility medications and in vitro fertilization, according to a new report.
By Emilie Shumway • Aug. 27, 2024 -
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Semaglutide coverage for weight loss could cost Medicare billions: study
If all newly eligible patients received semaglutide, Medicare Part D spending could increase by $34 billion to $145 billion each year, according to new research.
By Emily Olsen • Aug. 27, 2024 -
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Surprise BillingCMS has received 12K complaints of No Surprises noncompliance; won $1.7M in restitution
The most common complaints against providers were for surprise billing, while the top complaints for health plans included incorrectly calculating qualifying payment amounts.
By Rebecca Pifer Parduhn • Aug. 22, 2024 -
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Molina extends CEO Joe Zubretsky’s contract through 2027
Zubretsky also received a stock grant that will vest at the end of 2027 if the company meets financial targets. The shares would be worth nearly $51 million based on Molina’s stock price at market close on Tuesday.
By Emily Olsen • Aug. 21, 2024 -
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Large employers forecast 7.8% hike in health costs next year, thanks to rising pharmacy spend
The growing burden of pharmaceuticals is expected to be the primary driver of higher healthcare spending in 2025, mostly due to expensive GLP-1 drugs in demand for weight loss, according to the Business Group on Health.
By Rebecca Pifer Parduhn • Updated Aug. 21, 2024 -
The image by Renegomezphotography is licensed under CC BY-SA 4.0
Judge strikes down FTC noncompete ban nationwide
Obviating the ban has big implications for U.S. healthcare, an industry that frequently relies on noncompetes to lock medical workers into employment agreements with hospitals, insurers and other employers.
By Ryan Golden , Rebecca Pifer Parduhn • Aug. 21, 2024 -
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Humana pays $90M to settle whistleblower allegations of Medicare Part D fraud
The insurer, which did not admit wrongdoing, agreed to the deal on the eve of a jury trial.
By Rebecca Pifer Parduhn • Aug. 20, 2024
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