Biden’s plan to improve Medicare solvency targets prescription drugs

The plan — part of Biden’s 2024 budget proposal set to be released Thursday — would further reduce what Medicare pays for prescription drugs and raise taxes on Americans earning over $400,000.

By Rebecca Pifer Parduhn • March 7, 2023

Bright Health chases cash after overdrawing credit facility

Bright is facing a new threat to its solvency after overdrawing on credit amid efforts to discontinue its health insurance exchange business.

By Rebecca Pifer Parduhn • March 1, 2023

Gross margins in MA market returned to pre-pandemic levels by end of 2021, report finds

The analysis of insurer markets in 2021, the latest year of available annual data, sheds light into the varied financial performance of insurers during the COVID-19 pandemic.

By Sydney Halleman • March 1, 2023

Hacking healthcare: With 385M patient records exposed, cybersecurity experts sound alarm on breach surge

Healthcare companies must harden their defenses, but it may require regulators and lawmakers to raise the bar on security standards, experts say.

By Jasmine Ye Han • Feb. 28, 2023

CMS says surprise billing arbitration can resume for some disputes — others remain on pause

Regulators are continuing to work on new guidance in light of a court decision that ruled against the government and threw a wrench in the third-party process to resolve payment disputes between payers and providers.

By Samantha Liss • Feb. 27, 2023

Humana exits employer insurance, pivots focus to government plans

The insurer said its employer segment no longer meets Humana’s long-term strategic plans.

By Samantha Liss • Feb. 24, 2023

Partisan gridlock shouldn’t threaten true value in healthcare

Oak Street CEO Mike Pykosz makes the case for value-based healthcare policy despite potential partisan gridlock in the 118th Congress.

By Mike Pykosz • Feb. 24, 2023

Cigna secures restraining order, barring executive from joining CVS

A judge said Cigna “would suffer irreparable harm absent a temporary injunction” and that it was “inevitable” that the employee, Amy Bricker, would share or use Cigna’s trade secrets while at CVS. 

By Samantha Liss • Feb. 22, 2023

UnitedHealth closes $5.4B buy of home health business LHC

LHC will become part of UnitedHealth’s health services arm Optum to help deliver integrated care, as demand for home and community care increases.

By Rebecca Pifer Parduhn • Feb. 22, 2023

Medicaid enrollees largely unaware of upcoming redeterminations, survey finds

About 64% of adults in a Medicaid-enrolled family said they didn’t know they could lose coverage once eligibility checks resume on April 1, a survey from the Robert Wood Johnson Foundation found.

By Hailey Mensik • Feb. 21, 2023

Could Medicaid redeterminations cause short-term health plan signups to spike?

Short-term plan operators will likely ramp up their marketing in April to nab new consumers from the Medicaid churn, but health policy experts largely aren't concerned.

By Rebecca Pifer Parduhn • Feb. 21, 2023

LHC to delist from Nasdaq, suggesting UnitedHealth could complete acquisition next week

LHC’s delisting, a sign that the deal’s close could be imminent, doesn’t come as a surprise, as the Nasdaq notified the home health provider it wasn’t in compliance with the stock market’s listing standards in January.

By Rebecca Pifer Parduhn • Feb. 16, 2023

Boston Scientific, MDMA call for more transparency, oversight of Medicare Advantage plans

Privately offered Medicare Advantage plans “do not often provide a clear reason for the denial of coverage, and rarely offer any visibility into the evidence and methodology,” trade group MDMA and Boston Scientific said.

By Nick Paul Taylor • Feb. 15, 2023

CMS plans trio of experiments aimed at lowering drug costs

The pilot programs could allow adjusted payments for drugs cleared under accelerated approval and help states manage the costs of gene therapies.

By Christopher Newman • Feb. 15, 2023

Elevance Health closes deal to acquire BioPlus

BioPlus will now operate as a part of the insurer’s pharmacy benefit manager, CarelonRx.

By Sydney Halleman • Feb. 15, 2023

Surgical procedures cost significantly more at hospitals in networks versus independent facilities, study finds

The median price for a shoulder arthroscopy was $4,432 at hospitals within a network, compared to $2,643 at independent hospitals, new research in JAMA Network Open found.

By Hailey Mensik • Feb. 14, 2023

HHS pauses surprise billing arbitration after Texas court decision

The process by which health insurers and medical providers hash out payments for surprise bills is still in flux due to a series of lawsuits threatening the dispute resolution process.

By Rebecca Pifer Parduhn • Feb. 13, 2023

HHS readies for PHE wind down, end of pandemic flexibilities

A variety of pandemic-era policies will expire May 11, including those allowing providers to prescribe controlled substances via telehealth without an in-person visit and rules requiring payers to cover COVID-19 testing.

By Hailey Mensik • Feb. 10, 2023

Tipping point is in sight: Value-based care is driving meaningful financial results

Strata’s Liz Kirk shares her reflections on value-based care based on the 41st annual J.P. Morgan Healthcare Conference held in San Francisco.

By Liz Kirk • Feb. 10, 2023

Molina expects contract wins to offset Medicaid losses

The forecast comes as its competitor, Centene, expects to lose as many as 2.2 million Medicaid members when pandemic protections end and states resume eligibility checks.

By Samantha Liss • Feb. 9, 2023

Centene reaches $215M settlement with California

This latest settlement is the largest the payer has reached so far regarding state overcharging allegations.

By Samantha Liss • Feb. 9, 2023

Centene set to lose 2M Medicaid members as pandemic protections end

The insurer said it expects to add some members who are no longer eligible for Medicaid to its ACA exchange plans.

By Samantha Liss • Feb. 8, 2023

Cigna restricts coverage of new ALS drug, deepening fears about access

The health insurer’s national formulary considers Amylyx Pharmaceuticals’ Relyvrio to be "experimental, investigational or unproven for any use,” and now does not recommend covering it.

By Jacob Bell • Feb. 8, 2023

Biden zeroes in on drug costs during State of the Union address

The president called for extending Medicare's $35 insulin price cap to all Americans and blasted “big pharma” for record profits while at the same time “unfairly charging people hundreds of dollars.”

By Shannon Muchmore • Feb. 8, 2023

Top healthcare trends of 2023

Providers and payers are still grappling with the fallout from the COVID-19 pandemic, including the winding down of pandemic-era policies, which will have major effects on hospitals and insurers.

By Hailey Mensik • Feb. 8, 2023