State Medicaid officials project enrollment nosedive next year amid unwinding

Enrollment in the safety-net insurance program could plummet 8.6% in the 2024 fiscal year — the largest year-over-year drop since 1998, according to KFF.

By Rebecca Pifer • Nov. 14, 2023

New AMA policies focus on GLP-1 coverage, resisting corporate medicine

The lobbying group advanced a range of policy resolutions it says will advance access to patient care at its annual interim meeting.

By Susanna Vogel • Nov. 14, 2023

Explore the Trendline➔

Payer/provider relationships

As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.

By Healthcare Dive staff

How payers can advance health equity as part of coordinated action

When discussing the gap between the status quo and safe, high-quality healthcare, many organizations realize that improving health equity is a moral and economic imperative as the business case for equity is well-documented.

Nov. 13, 2023

Optum Rx moves 8 insulins to preferred formulary status as pressure mounts on PBMs

The drugs shifting to preferred status — meaning they’ll be available for under $35 per month in out-of-pocket costs — were previously on tier three or excluded altogether from the pharmacy benefit manager’s formulary lists.

By Rebecca Pifer • Nov. 10, 2023

Medicare Advantage seniors have better health outcomes, study finds

New research from Harvard and Inovalon found MA beneficiaries had fewer hospital readmissions, fewer preventable hospitalizations and lower rates of high-risk medication use than those in traditional Medicare.

By Rebecca Pifer • Nov. 9, 2023

Biggest takeaways from health insurers’ third-quarter earnings

Many payers beat Wall Street expectations in the quarter, despite ongoing utilization concerns. Other hot topics? Medicare Advantage stars, Medicaid redeterminations, individual exchange growth and GLP-1s.

By Rebecca Pifer • Nov. 8, 2023

Biden administration proposes capping broker payment in MA, following pressure

The new proposed rule is meant to stop brokers from steering beneficiaries to plans based on excessive compensation. It’s regulators’ latest move to curb Medicare Advantage marketing misconduct following a push from lawmakers.

By Rebecca Pifer • Nov. 7, 2023

Medicaid disenrollments pass 10M as states continue eligibility checks

States have assessed the eligibility of 28 million Americans to date, and terminated coverage for 35% of them, according to the latest data from KFF.

By Rebecca Pifer • Nov. 6, 2023

CMS finalizes 2024 Medicare hospital, doctor payments, 340B fix and price transparency requirements

Regulators finalized a number of rules Thursday with sweeping implications for providers in the Medicare program, including rates for next year that doctors and hospitals slammed as insufficient.

By Rebecca Pifer • Nov. 3, 2023

Walmart inks partnerships with health system, insurer in Florida

The partnerships — which include Walmart Health’s first patient care coordination agreement with a health system — aim to improve care coordination and referrals from its 23 health centers in the state.

By Emily Olsen • Nov. 2, 2023

Cigna raises 2023 membership outlook amid healthier economy

An expected economic downturn has yet to materialize, leading Cigna to say Thursday it plans to add at least 1.6 million members this year, up from previous forecasts.

By Rebecca Pifer • Nov. 2, 2023

CVS beats expectations in Q3, but high costs weigh on profit outlook

The company is prepared for potential legislation forcing transparency in its pharmacy benefit manager business practices later this year, CEO Karen Lynch said on Wednesday.

By Rebecca Pifer • Nov. 1, 2023

Humana reports medical cost growth from MA utilization

The payer expects higher levels of Medicare Advantage utilization to continue for the remainder of the year, outgrowing past expectations.

By Sydney Halleman • Nov. 1, 2023

Tracking healthcare data breaches

A breach at a North Carolina health center in February exposed the data of more than 450,000 people.

By Emily Olsen , Susanna Vogel • Updated Sept. 25, 2025

Biden administration overhauls surprise billing resolution process amid controversy

Regulators say they're trying to make payment dispute resolutions more fair and efficient following more than a year of industry complaints.

By Rebecca Pifer • Oct. 30, 2023

Insurer prices vary widely by U.S. region, study finds

Humana charged higher rates for the same services in the Upper Midwest and Southeast compared to the Central U.S. and Florida, according to new research published in JAMA.

By Susanna Vogel • Oct. 30, 2023

Molina lowers Medicaid member retention rate post-redeterminations

But the California insurer’s forecast of $38 billion in premium revenue next year remained unchanged, thanks to new contract wins.

By Rebecca Pifer • Oct. 26, 2023

Insurance coverage not a panacea for healthcare affordability: survey

Numerous studies have outlined how high medical costs affect uninsured individuals, but healthcare prices are straining household budgets regardless of insurance type, according to the Commonwealth Fund.

By Rebecca Pifer • Oct. 26, 2023

Defunct direct contracting model saved Medicare $372M last year

Value-based primary care chains for seniors operated by major retail health players did particularly well, with Amazon’s Iora, CVS’ Oak Street and Walgreens’ VillageMD all notching high net savings.

By Rebecca Pifer • Oct. 25, 2023

Blue Shield of California is promising a simpler, cheaper pharmacy benefits model. Can it deliver?

Big questions hang over the California health insurer's bold experiment — having five vendors carry out PBM functions previously performed by one — that could threaten BSCA's expected savings.

By Rebecca Pifer • Updated Oct. 26, 2023

Centene beats Q3 forecasts despite stars, redeterminations pressures

The payer’s Medicare Advantage star ratings have improved slightly, but “certainly do not reflect the ambitions of our company,” CEO Sarah London said.

By Rebecca Pifer • Oct. 24, 2023

2.3M people would gain coverage if 10 remaining states expanded Medicaid, report finds

Black people, young adults and women, especially those of reproductive age, would see the biggest coverage gains, according to the Robert Wood Johnson Foundation and the Urban Institute.

By Emily Olsen • Oct. 24, 2023

Blue Cross NC closes purchase of FastMed urgent care clinics

The insurer also named Jim Moffett, who previously worked at a Florida-based division of Trinity Health, as the urgent care chain’s CEO.

By Emily Olsen • Updated Jan. 18, 2024

Express Scripts sued by independent pharmacies over alleged price fixing

The Cigna-owned pharmacy benefit manager colluded with rival Prime Therapeutics to overcharge pharmacies, according to a lawsuit filed last week.

By Rebecca Pifer • Oct. 23, 2023

Walgreens, Alignment partner on co-branded MA plans

The zero-dollar premium plans will be available in 10 counties in Arizona, California, Florida and Texas starting next year.

By Emily Olsen • Oct. 18, 2023