Payer: Page 37
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Courtesy of Eisai
Eisai, in pricing new Alzheimer’s drug, tries to sidestep controversy
The pharma set the average annual cost of it and Biogen’s newly approved medicine Leqembi to $26,500, below the cost of the companies’ earlier drug Aduhelm but above one estimate of cost effectiveness.
By Ned Pagliarulo • Jan. 9, 2023 -
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FDA approves Alzheimer’s drug from Eisai, Biogen in closely watched decision
The agency’s approval comes months after a large clinical trial showed the drug, called Leqembi, could slow the disease’s progression. Yet experts have raised concerns about its safety.
By Jacob Bell • Jan. 6, 2023 -
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 -
California revises Medicaid contract awards, adding 2 insurers
Five insurers will now receive lucrative contracts to provide managed care services, starting in 2024, in the country’s largest Medicaid market.
By Susan Kelly • Jan. 4, 2023 -
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Surprise BillingThe portal to resolve surprise bills has been inundated with disputes — SCP Health tops the list
Federal agencies received more disputes in a five-month window than they expected to receive in a full year.
By Samantha Liss • Updated Jan. 9, 2023 -
Samantha Liss/Healthcare Dive
Centene reaches $44M settlement with Iowa
It’s the latest deal in a string of settlements to resolve allegations the nation’s largest Medicaid managed care organization overcharged states for pharmacy services.
By Samantha Liss • Dec. 21, 2022 -
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Stakes are high in California’s Medicaid market shakeup
Four insurers that lost out on lucrative contracts in the state’s first-ever competitive process are challenging the state's picks.
By Susan Kelly • Dec. 21, 2022 -
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Surprise BillingJudge questions surprise billing ban implementation during court hearing
A federal judge on Tuesday tested the government’s defense concerning a rule designed to help third parties resolve payment disputes between providers and insurers.
By Samantha Liss • Dec. 21, 2022 -
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CMS rule aimed at improving Medicare Advantage draws praise
Proposed changes target prior authorization holdups and misleading advertising while aiming to expand access to behavioral health care and affordable prescriptions.
By Susan Kelly • Dec. 19, 2022 -
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Surprise BillingTexas Medical Association heads to court again in second challenge to surprise billing ban
The TMA is continuing to argue the surprise billing ban unfairly benefits insurers. It will argue before the same judge who previously sided with the group in a separate but similar case.
By Samantha Liss • Dec. 19, 2022 -
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OpinionVirtual care and MA stars: value for seniors and for health plans
Kelly Bliss, Teladoc’s head of U.S. group health, makes the case for virtual care’s efficacy in improving MA star ratings.
By Kelly Bliss • Dec. 19, 2022 -
Samantha Liss/Healthcare Dive
Centene again shakes up C-suite
The changes come as the insurer outlined its financial expectations for next year ahead of its investor day on Friday.
By Samantha Liss • Dec. 16, 2022 -
Illustration: Xavier Lalanne-Tauzia for Industry Dive
Healthcare leaders expect turbulent operating environment next year
Staffing challenges and high inflation are expected to continue into 2023, along with affordability issues for patients, shrinking margins and continual supply chain disruptions, according to a survey from Deloitte.
By Hailey Mensik • Dec. 16, 2022 -
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Scan Group, CareOregon to merge, forming $6.8B health plan
Together the two will serve nearly 800,000 Medicaid and Medicare members across five states, giving them greater scale to take on competitors.
By Samantha Liss • Dec. 15, 2022 -
Photo: Will Warasila for Industry Dive
Deep DiveFor ALS patients, doctors, a new medicine reignites concerns about healthcare access
The drug Relyvrio is in high demand in ALS clinics across the U.S. Though some patients are already getting it, insurance coverage and out-of-pocket costs remain a source of anxiety.
By Jacob Bell , Shaun Lucas • Dec. 15, 2022 -
Alex Wong via Getty Images
CMS estimates 41.5M people affected by innovation center models since late 2020
The Center for Medicare and Medicaid Innovation is currently operating 33 models studying potential improvements in healthcare payment and delivery.
By Rebecca Pifer • Dec. 14, 2022 -
Spencer Platt via Getty Images
Bright Health in danger of being booted from NYSE
The insurtech, which went public last year, has struggled with medical costs during the pandemic and has shrunk its business over the past year.
By Rebecca Pifer • Dec. 13, 2022 -
Alex Wong via Getty Images
CMS tackles provider availability, exchange regulations in proposed rule
The regulation comes after the ACA exchanges, spurred by financial incentives during the COVID-19 pandemic, reached record enrollment numbers.
By Sydney Halleman • Dec. 13, 2022 -
Variability in Medicare direct contracting savings illustrates promises, pitfalls of value-based care
Accountable care organizations' net savings rates ranged from -29.4% to 29.2% in the 2021 Global and Professional Direct Contracting Model.
By Rebecca Pifer • Updated Dec. 13, 2022 -
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Progressive lawmakers call on CMS to cull companies with history of Medicare fraud from ACO REACH
At least 10 organizations with records of healthcare fraud and abuse participated in the direct contracting program last year despite CMS screening requirements, the letter said.
By Rebecca Pifer • Updated Dec. 20, 2022 -
Samantha Liss/Healthcare Dive
Centene reaches $17M settlement with Oregon
The payer has reached settlements with 13 states over allegations it overcharged Medicaid programs.
By Samantha Liss • Dec. 9, 2022 -
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Payers, providers applaud new CMS prior authorization rule
Provider groups, including the AHA, asked the Senate to codify measures proposed by the CMS by passing bipartisan legislation imposing more prior authorization requirements on Medicare Advantage plans.
By Rebecca Pifer • Dec. 8, 2022 -
UnitedHealth’s $5.4B buy of LHC expected to close in Q1
UnitedHealth’s buy of home health provider LHC Group for $170 a share could close as early as Jan. 6.
By Rebecca Pifer • Dec. 7, 2022 -
Alex Wong via Getty Images
CMS proposes new prior authorization requirements for payers, including MA plans
Regulators want payers to issue coverage decisions within 72 hours for urgent prior authorization requests — but the final turnaround time could be even shorter.
By Rebecca Pifer • Dec. 7, 2022 -
Karen Ducey via Getty Images
Medicaid redeterminations18M projected to lose Medicaid coverage at end of COVID-19 emergency
Many people who are currently enrolled in Medicaid will transition to other coverage, but 3.8 million people will completely lose insurance, according to the Robert Wood Johnson Foundation.
By Susan Kelly • Dec. 6, 2022 -
Brandon Bell via Getty Images
Key healthcare stories from 2022
This year has been especially tumultuous for healthcare, with the overturning of Roe v. Wade, numerous labor disputes and major M&A announcements.
By Shannon Muchmore • Dec. 5, 2022
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