PBMs, PhRMA trade blame over drug costs in House hearing

Pharmacy benefit manager lobby PCMA and drugmaker lobby PhRMA pointed fingers over problems in the prescription supply chain during the House committee's second PBM hearing on Tuesday.

By Rebecca Pifer Parduhn • Sept. 19, 2023

Tennessee BCBS sued by former employees over COVID vaccine mandate

The new lawsuit alleges the nonprofit health plan violated employees' religious rights by not granting them an exemption to its inoculation requirement.

By Rebecca Pifer Parduhn • Sept. 18, 2023

Explore the Trendline➔

Payer/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

CMMI teases new behavioral, maternal health models launching this year

The timeline of the two upcoming models could be pushed back if Congress doesn’t come to a funding agreement and the government shuts down, CMMI head Liz Fowler said.

By Rebecca Pifer Parduhn • Sept. 15, 2023

Majority of ground ambulance rides were out of network in 2022, report finds

Patients often have little choice of ambulance provider, and federal law doesn’t protect them from surprise bills from the rides.

By Emily Olsen • Sept. 14, 2023

BCBSA finds wide variety in medical cost by site

Researchers said their data supports site-neutral proposals to make care cost the same regardless of where it’s provided. Momentum is building in Congress around the policies, but they face fierce opposition from hospitals.

By Rebecca Pifer Parduhn • Sept. 14, 2023

GoodRx, MedImpact partner on automatic drug discounts

The digital health company has notched its third partnership with a PBM in a bid to increase access to its drug discount coupons.

By Rebecca Pifer Parduhn • Sept. 14, 2023

PBM reforms in Congress would have modest effect at best and backfire at worst, Brookings says

Congress is inching closer to pharmacy benefit manager reform with new legislation released last week. But even eliminating all PBM profits would barely move the needle on U.S. drug spending, according to a new report.

By Rebecca Pifer Parduhn • Sept. 13, 2023

CVS CEO ‘optimistic’ payer will improve MA star ratings

At Morgan Stanley’s healthcare conference on Tuesday, Karen Lynch also called into question the $500 million in savings Blue Shield of California expects from kicking CVS’ pharmacy benefit manager to the curb.

By Rebecca Pifer Parduhn • Sept. 13, 2023

Low-income seniors more likely to report fraudulent marketing from private Medicare plans

The Commonwealth Fund survey comes after regulators finalized a rule this spring aiming to cut back on deceptive and misleading advertising for Medicare Advantage plans after beneficiary complaints rose.

By Emily Olsen • Sept. 12, 2023

L.A. Care to pay $1.3M to settle potential HIPAA breach violations

The settlement comes after state regulators levied a $55 million fine against the health plan last year for alleged operational deficiencies, including failure to address a backlog of over 9,000 prior authorization requests.

By Sydney Halleman • Sept. 12, 2023

Employers expect health benefit costs to climb 5.4% in 2024

High inflation, labor shortages and industry consolidation contributed to the projected increase, according to a new survey of employers from consultancy Mercer.

By Brian T. Horowitz • Sept. 11, 2023

MA enrollment in rural areas nearly quadrupled since 2010, KFF finds

More rural seniors are turning to Medicare Advantage, but the plans can offer limited provider networks. That could prove an additional challenge for rural beneficiaries who already have to travel further distances for care.

By Emily Olsen • Sept. 8, 2023

CVS shuffles C-suite, appoints CFO as head of health services

Shawn Guertin will now helm the healthcare giant's suite of care delivery businesses, including Oak Street and Signify, as CVS undergoes a major corporate restructuring following flagging profits.

By Rebecca Pifer Parduhn • Sept. 8, 2023

Astellas withdraws lawsuit challenging Medicare drug price program

Contrary to the drugmaker’s expectations, its top-selling cancer medicine Xtandi wasn’t picked as one of the first 10 drugs to face price negotiations.

By Ned Pagliarulo • Sept. 7, 2023

MA plans were overpaid $9.3B annually from 2017 to 2020, study finds

Favorable selection of healthier beneficiaries led to overpayments in counties with high Medicare Advantage penetration, but benchmark changes could mitigate the impact.

By Emily Olsen • Sept. 6, 2023

CMS creates all-payer funding opportunity for states

Regulators' latest effort to nudge the U.S. away from fee-for-service takes a page from how Maryland pays its hospitals.

By Rebecca Pifer Parduhn • Sept. 6, 2023

Patients ‘steered’ toward health systems, more costly treatment after vertical consolidation, study finds

Consolidation between primary care physicians and large health systems led to increased costs per patient, according to a new study published in JAMA.

By Susanna Vogel • Sept. 5, 2023

Humana sues HHS over Medicare Advantage audits

The payer, which brings in the bulk of its revenue from Medicare, is fighting a rule finalized earlier this year to claw back overpayments in the increasingly popular MA program.

By Rebecca Pifer Parduhn • Sept. 5, 2023

‘We’re in the 1999 of the internet era’: a16z’s Julie Yoo on fintech’s potential and the digital health market

Yoo, who leads health tech investment at venture capital firm Andreessen Horowitz, outlined her fintech investment thesis and why the healthcare industry is at an inflection point for adoption.

By Rebecca Pifer Parduhn • Aug. 31, 2023

Prisma Health files suit against UnitedHealthcare, alleging ‘bad faith’ contract negotiation tactics

The South Carolina-based health system alleges that the insurer broke its contract and gave "false and misleading" statements to the press about Prisma’s proposed rates for 2024.

By Susanna Vogel • Aug. 31, 2023

Medicaid cracks down on states over children wrongly losing coverage during redeterminations

The Biden administration is threatening state Medicaid agencies with sanctions after finding an automation glitch that could cause eligible children to lose coverage.

By Rebecca Pifer Parduhn • Aug. 31, 2023

Employers should focus on provider quality to cut low-value care in plans, report finds

In the employer-sponsored insurer market, employers play a “critical” role when it comes to quality and outcomes, according to a report by Morgan Health and Embold Health.

By Emily Olsen • Aug. 30, 2023

Humana launches in-home senior care program through CenterWell in Georgia, Louisiana

The program builds on Humana’s acquisition of home-based primary care provider Heal earlier this year, and could expand to 10 additional southern and southwestern states.

By Rebecca Pifer Parduhn • Updated Aug. 30, 2023

Bon Secours sues Anthem BCBS over unpaid claims

The Cincinnati-based health system is alleging the Elevance subsidiary owes $93 million following four years of contract disputes.

By Rebecca Pifer Parduhn • Aug. 29, 2023

Cigna to exit Missouri and Kansas ACA marketplaces in 2024

The insurer will offer ACA marketplace plans in two fewer states after announcing it would expand its presence on the exchanges last year. 

By Emily Olsen • Aug. 28, 2023