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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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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 -
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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 -
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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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Court strikes down HHS change to low-income payment formula in win for Texas hospitals
The case centered on whether patients who receive funds from a pool of state money for uncompensated care could be included in calculating hospitals’ disproportionate share funding.
By Rebecca Pifer Parduhn • Aug. 19, 2024 -
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Employer healthcare costs projected to rise 9% in 2025: Aon
Inflation, expensive specialty drugs and demand for pricey glucagon-like peptide 1 medications, or GLP-1s, are pushing costs higher, according to the professional services company.
By Emily Olsen • Aug. 19, 2024 -
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Medicare drug price cuts could have limited early impact, but grow with time
Some industry watchers described the level of price discounts announced by Medicare as a "relief," though they warned of bigger future implications for drug research.
By Jonathan Gardner • Aug. 16, 2024 -
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Deep DiveMedicaid overtakes Medicare Advantage as health insurers’ bogeyman in Q2
Despite challenges in Medicaid and MA, major insurers still posted large earnings in the second quarter — many helped by health services divisions.
By Rebecca Pifer Parduhn • Aug. 15, 2024 -
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Medicare reveals results of drug price negotiations
The agency said the first round of pricing talks, which involved drugs like the blood thinners Eliquis and Xarelto, will result in $6 billion in savings for taxpayers.
By Ned Pagliarulo • Aug. 15, 2024 -
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Medicare Advantage prior authorization denials increased in 2022: KFF
More than 80% of denied requests were overturned when appealed, but few beneficiaries formally questioned the decisions.
By Emily Olsen • Aug. 14, 2024 -
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Elevance, Clayton Dubilier and Rice unveil primary care venture Mosaic Health
New information is emerging about the joint care delivery platform first teased earlier this spring, which is launching without Elevance’s assets.
By Rebecca Pifer Parduhn • Aug. 14, 2024 -
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CMS finalizes notice on Medicare coverage for breakthrough devices
The CMS will consider five medical device candidates yearly for national coverage through the new pathway, called Transitional Coverage for Emerging Technologies.
By Elise Reuter • Aug. 8, 2024 -
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Aetna executive ousted as CVS’ Medicare Advantage woes drag into second quarter
On Wednesday, CVS slashed its earnings guidance for the third time this year, announced a plan to cut $2 billion in costs and fired the head of its insurance division Aetna, which continues to struggle with high medical utilization.
By Rebecca Pifer Parduhn • Aug. 7, 2024 -
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Uninsured rate jumps to 8.2% amid Medicaid unwinding: CDC
Growth in the nation’s uninsured rate could become steeper if subsidies in the Affordable Care Act exchanges expire on schedule next year, according to health policy experts.
By Rebecca Pifer Parduhn • Aug. 7, 2024 -
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Premiums for ACA plans to grow 7% next year: KFF
Insurers cited workforce shortages, hospital consolidation and growing demand for pricey GLP-1 drugs as reasons driving the premium increases for 2025.
By Rebecca Pifer Parduhn • Aug. 7, 2024 -
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Surprise BillingAppeals court hands providers latest win in No Surprises litigation
The 5th Circuit Court’s decision vacates instructions that arbiters should first consider the qualifying payment amount in deciding payments over contested out-of-network bills. Providers argued that unfairly advantaged insurers.
By Rebecca Pifer Parduhn • Aug. 6, 2024 -
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Cigna CEO promises ‘aggressive’ defense of pharmacy benefit managers
David Cordani’s comments to investors Thursday come as the payer blew past Wall Street’s expectations for the second quarter, helped by significant growth in its health services division — including PBM Express Scripts.
By Rebecca Pifer Parduhn • Aug. 1, 2024 -
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Disadvantaged areas less likely to have high-quality Medicare Advantage plans, study finds
The research, which found socially vulnerable counties were more likely to have MA plans rated under 3.5 stars, is the latest highlighting the importance of location in healthcare access.
By Rebecca Pifer Parduhn • July 31, 2024
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