Payer: Page 5

  • UnitedHealth Group office
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    Courtesy of UnitedHealth Group
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    UnitedHealth commits to changes after independent review

    The healthcare behemoth released results of three highly anticipated external reviews that drilled down on a number of areas for improvement.

    By • Dec. 22, 2025
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    Trump administration proposes stronger insurer price transparency requirements

    The proposed rule aims to tamp down on unwieldy price data files and change how some prices are reported.

    By • Dec. 22, 2025
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    Alex Wong via Getty Images
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    Medicare unveils successor to ACO REACH

    The value-based care pilot will be replaced by ACO LEAD, a new model that providers and analysts say seems to address many of the problems posed by its predecessor.

    By • Dec. 19, 2025
  • A tan and black monument sign with bold orange "Optum" lettering and the address "11000 Optum Circle" sits on a grassy lawn with low shrubs in front of a large, modern office building with glass windows and beige panels. Bare trees and a cloudy sky are in the background.
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    Alamy
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    Optum Rx says 100% of network community pharmacies in cost-based contracts

    PBMs are pivoting reimbursement models to protect pharmacies from what they say is an unsustainable status quo.

    By • Dec. 18, 2025
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    Kayla Bartkowski via Getty Images
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    House passes Republican health bill without ACA subsidy extension

    The legislation makes no mention of the financial assistance, setting the subsidies up to lapse in just a few weeks.

    By • Dec. 18, 2025
  • A red-brick mid-rise office building with rows of windows and a “Humana” sign on the roof, seen under a cloudy gray sky.
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    Neiu20001 via Getty Images
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    Humana taps ex-Amazon executive as incoming insurance head

    George Renaudin, who has been with Humana for almost 30 years, is retiring, the insurer announced Tuesday. Aaron Martin, previously Amazon’s vice president of healthcare, will take his place.

    By • Dec. 17, 2025
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    JHVEPhoto via Getty Images
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    Deep Dive

    Goliath v. Goliath

    A Medicare Advantage network spat between Optum and Humana in Washington state appears to be benefiting UnitedHealthcare at the expense of its biggest rival. Antitrust experts are alarmed.

    By • Dec. 16, 2025
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    Getty / VioletaStoimenova

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    Sponsored by Zelis

    How health plans can boost star ratings with smarter member engagement

    Struggling with Star Ratings? Discover how smarter engagement can turn scores around.

    Dec. 15, 2025
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    Win McNamee via Getty Images
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    Senate rejects competing health bills, setting up ACA subsidy lapse

    The failure of both bills means enhanced subsidies for Affordable Care Act plans will likely expire at the end of the year. Healthcare groups urged lawmakers to extend the subsidies, noting premiums could skyrocket.

    By • Dec. 11, 2025
  • picture of a window inside a room where people sit at tables to enroll in healthcare insurance
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    Joe Raedle/Getty Images via Getty Images
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    Democrats’ ACA subsidy extension adds $83B to deficit, boosts insured: CBO

    The plan to extend the more generous financial assistance for three years is expected to go up for a vote in the Senate Thursday, alongside a Republican alternative that would replace the subsidies. 

    By • Dec. 11, 2025
  • Elevance headquarters is a large white and brown building surrounding a grassy quad.
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    Permission granted by Elevance Health
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    Ex-Pfizer executive joins Elevance’s board as insurer pursues pharmacy experience

    Amy Schulman is the second veteran of the pharmaceutical industry that Elevance has added to its board this year.

    By • Dec. 11, 2025
  • David Joyner speaks in front of a blue background.
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    Rebecca Pifer/Healthcare Dive
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    CVS to launch ‘engagement’ platform in gamble on consumer, industry interest

    CVS is bringing together its disparate businesses onto one platform, and giving its rivals the option to add their products and services as well. The goal is to improve consumers’ health engagement while generating more revenue.

    By • Dec. 10, 2025
  • A sign reading OBAMACARE hangs outside a storefront.
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    Joe Raedle via Getty Images
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    Early ACA enrollment holds steady despite subsidy turmoil

    Some 5.8 million people have signed up for 2026 ACA plans so far, up about 7% year over year. Still, enrollment tends to shift over signup periods, so it’s too early to conclude that the Obamacare exchanges won’t shrink next year.

    By • Dec. 10, 2025
  • Cassidy speaks in front of poster board during a Senate Finance Committee hearing.
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    Rebecca Pifer/Healthcare Dive
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    Crapo, Cassidy propose enhanced ACA subsidy alternative

    The legislation, which is scheduled for a vote Thursday, would send funds directly to health savings accounts paired with bronze or catastrophic plans offered on the Affordable Care Act exchanges.

    By • Dec. 10, 2025
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    Getty Images
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    1 in 4 ACA enrollees could go uninsured if subsidies lapse: KFF

    Nearly 60% of survey respondents said they wouldn’t be able to afford a $300 annual increase in healthcare costs without significantly disrupting their finances.

    By • Dec. 8, 2025
  • Aetna headquarters building with the Aetna logo on its facade.
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    Getty Images
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    Aetna updates on prior authorization reform

    The CVS-owned payer is working to bundle multiple prior authorizations for certain conditions into one single review.

    By • Dec. 5, 2025
  • A picture of senator bill cassidy at a senate committee hearing, raising his right hand.
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    Kevin Dietsch/Getty Images via Getty Images
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    Senators agree they need to act on expiring ACA subsidies. But they can’t nail down how.

    Hidden in Republicans’ ACA bashing during a health committee hearing last week were some signs that a clean extension of more generous subsidies isn’t completely off the table — though one still doesn’t look likely.

    By • Dec. 4, 2025
  • A sign reading OBAMACARE hangs outside a storefront.
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    Joe Raedle via Getty Images
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    Covert watchdog testing finds ACA vulnerable to subsidy fraud

    The Government Accountability Office successfully enrolled 18 out of 20 fake applicants in subsidized ACA plans. Republicans jumped on the report as ammunition in the debate over expanded subsidies.

    By • Dec. 4, 2025
  • CVS pharmacy sign outside of Miami, Florida on Feb. 7, 2024
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    Joe Raedle via Getty Images
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    CVS agrees to pay $38M to settle insulin fraud claims

    For a decade, CVS knew it was skirting rules meant to limit overprescribing but did nothing to stop, according to the Department of Justice.

    By • Dec. 3, 2025
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    Humana appeals Medicare Advantage star ratings loss to 5th Circuit

    The insurer continues to try to prove that regulators acted arbitrarily in downgrading its quality scores for 2025, despite numerous setbacks in the courts to date.

    By • Dec. 1, 2025
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    Why Medicare Advantage contract negotiations are getting heated

    “There’s simply more at stake in these negotiations for payers and providers than there used to be,” one expert said.

    By Michael Brady • Nov. 26, 2025
  • Medicare enrollment form and money.
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    CMS proposes overhauling Medicare Advantage star ratings

    The agency suggested cutting a dozen quality measures where health plan performance is high and beneficiaries can’t easily distinguish between offerings.

    By • Nov. 26, 2025
  • Two prescription drug cartons stand side by side on a counter, each bearing the word Wegovy.
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    Scott Olson via Getty Images
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    CMS sets 2027 Medicare prices for Wegovy, Trelegy and 13 other drugs

    The second round of negotiations cuts spending an aggregate 44% over 2024 list prices as the federal government extends restraints over more medicines.

    By Jonathan Gardner • Nov. 26, 2025
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    Trump administration appeals decision vacating Medicare Advantage audit rule

    A federal judge struck down the rule that would have clawed back billions of dollars in overpayments in September. Now, the HHS wants to take the case to the Fifth Circuit Court of Appeals.

    By • Nov. 25, 2025
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    Getty Images
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    CMS finalizes 2.6% outpatient pay bump, site-neutral policies

    Hospitals lambasted the final rule as inadequate, arguing the sector is facing significant financial pressures.

    By • Nov. 24, 2025