Payer: Page
-
Getty Images
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 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/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 -
Getty Images
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 -
Getty Images
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 -
Getty Images
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 -
Getty Images
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 -
Julia Rendleman via Getty Images
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 -
Samuel Corum/Getty Images via Getty Images
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 -
Anna Moneymaker via Getty Images
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 -
Mario Tama via Getty Images
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 -
Getty Images
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 -
Getty Images
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 -
Getty Images
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 -
Getty Images
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 -
Drew Angerer via Getty Images
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 -
Getty Images
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 -
David Greedy via Getty Images
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 -
Getty Images
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 -
Getty Images
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
Previous
