Payer: Page 3


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    Mario Tama via Getty Images

    Labor union health fund targets hospital prices, looks to form purchasing coalition

    If successful, the coalition would bring together New York City's largest public employee union and the United Federation of Teachers. Together the group would represent about 540,000 people.

    By March 22, 2022
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    Rebecca Pifer/Healthcare Dive
    HIMSS22

    Payer-to-payer data exchange rule to be published 'soon,' CMS head says at #HIMSS22

    CMS hasn't been enforcing stipulations that payers share patient data with competitors set out in regulations finalized two years ago. But that could change soon with a new rule.

    By March 15, 2022
  • Explore the Trendline
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    Yujin Kim/Healthcare Dive
    Trendline

    Payer/Provider relationships

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

    By Healthcare Dive staff
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    Permission granted by Biogen

    Biogen and its partner rework terms of Aduhelm deal amid slow sales

    Instead of sharing global profits and losses, Eisai will receive royalties tied to net sales of the Alzheimer's drug. Biogen, meanwhile, said the amended deal should make it easier to "address market developments."

    By Jacob Bell • March 15, 2022
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    Dollar Photo Club

    Sutter Health defeats antitrust challenge in jury trial

    The federal jury in a class action suit rejected allegations that the California hospital system drove up healthcare costs in its markets through anti-competitive practices.

    By Susan Kelly • March 14, 2022
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    Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.

    Grassley pushes for PBM probe

    The senator wants FTC commissioners to come up with a more targeted focus for the study and suggested narrowing a review to the impact on consumers and their out-of-pocket costs.

    By March 14, 2022
  • Anthem plans to change name to Elevance

    It's the second name change for Anthem in the past decade. Prior to 2014, the company was known as WellPoint.

    By March 10, 2022
  • Medical groups say prior authorization burdens persisted during pandemic

    A new survey of doctor practices from the Medical Group Management Association found 98% of respondents wrestled with an increased or steady level of prior authorization requirements over the past year.

    By Susan Kelly • March 8, 2022
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    Fotolia

    L.A. Care fined $55M after members faced barriers to timely care

    The fine is reportedly the largest in California history following an investigation that revealed serious systemic failures.

    By March 7, 2022
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    Samara Heisz via Getty Images

    Civica targets insulin in effort to produce cheaper drugs

    The nonprofit group announced ambitious plans to begin offering insulin at prices no higher than $30 per vial by early 2024.

    By Kristin Jensen • March 4, 2022
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    Geisinger

    Humana adds Cerner's Feinberg to board amid activist pressure

    Longtime Humana board member Marissa Peterson will not stand for reelection at the upcoming shareholder meeting, according to a proxy statement.

    By Updated March 9, 2022
  • Primary care physician turnover costs payers almost $1B every year, study finds

    Disruptions in care continuity when primary care providers leave their practices was a costly issue even before the pandemic, according to the American Medical Association.

    By March 3, 2022
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    Win McNamee / Staff via Getty Images

    Biden discusses drug prices, mental health services in annual address

    The president also announced a "test to treat" program that would allow people to receive a COVID-19 test at a pharmacy and immediately receive free antiviral pills, such as Pfizer's Paxlovid or Merck's molnupiravir.

    By March 2, 2022
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    Alex Wong via Getty Images

    CMS redesigns controversial Medicare direct contracting model

    The decision to retain the direct contracting model — albeit with numerous changes and a new name — was met with mixed reactions from stakeholders.

    By Feb. 28, 2022
  • DOJ moves forward with suit to block UnitedHealth's acquisition of Change

    The lawsuit alleges that if UnitedHealth acquired Change, the payer would be able to gain a competitive advantage by seeing "very competitively sensitive" data from other insurers.

    By Feb. 25, 2022
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    Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.

    FTC seeks public comments on pharmacy benefit managers' impact on patients, pharmacies

    After a failed bid to launch a formal inquiry into PBMs, the FTC now says it wants to collect comments from the public to study a wide array of PBM practices. 

    By Feb. 25, 2022
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    Courtesy of One Medical

    One Medical partnering with Connecticut health system, but stock drags on high MLR

    CEO Amir Dan Rubin told analysts in a call Wednesday that COVID-19 headwinds continue, including staffing shortages, a lag in return to care and reduced revenue from testing.

    By Feb. 24, 2022
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    Courtesy of Humana

    Humana agrees to board refresh in deal with activist hedge fund

    It's the latest insurer facing pressure from an activist investor group, following a shakeup at Centene.

    By Feb. 23, 2022
  • Ground ambulance costs continue to soar, study finds

    More ambulance trips are billing for "advanced life support," denoting a higher level of care (and reimbursement). Private insurers' payments for those trips increased 56% between 2017 and 2020, Fair Health found.

    By Feb. 22, 2022
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    Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.

    FTC to vote on investigation into PBMs' drug pricing practices

    The agency's commissioners will weigh Thursday whether to investigate PBMs and their relationship to drug prices and "practices that may disadvantage independent or specialty pharmacies," according to the meeting agenda.

    By Feb. 17, 2022
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    Retrieved from FTC.

    FTC fails to get enough votes to launch study into PBM practices

    Numerous pharmacists urged commissioners to probe the practices of PBMs, which they allege harm their independent pharmacies and threaten to drive them out of business.

    By Feb. 17, 2022
  • Molina plans steep reduction in marketplace enrollment

    The payer is expected to lose two-thirds of its marketplace enrollment by the end of the year, according to executives.

    By Feb. 16, 2022
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    UnitedHealth Group

    DOJ has until Feb. 27 to sue to block UnitedHealth's $8B Change acquisition

    The companies said they would give the DOJ 10 days notice before completing the merger, during which the DOJ could launch a lawsuit to block it. On Feb. 17, UnitedHealth and Change gave the regulators that notice.

    By Updated Feb. 22, 2022
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    CMS

    Smaller rivals snap up Medicare Advantage members

    MA startups were able to win market share during the most recent open enrollment period, threatening the market share of incumbents and suggesting more willingness to shop among U.S. seniors.

    By Feb. 9, 2022
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    Bruce Bennett via Getty Images

    Boosters and test demand — coupled with lower COVID-19 treatment costs — drove CVS profit up 33% in Q4

    People flocked to get booster shots as the omicron variant drove a sharp increase in testing, boosting revenue for CVS' drugstore segment. Meanwhile, its payer arm reported lower-than-expected COVID-19 treatment costs.

    By Feb. 9, 2022
  • Jury trial gets underway in antitrust suit against Sutter Health

    The California hospital system is accused of wielding its market power to drive up health insurance premiums for hundreds of thousands of consumers.

    By Susan Kelly • Feb. 9, 2022