Payer: Page 5
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Molina cuts earnings guidance as costs rise in government programs
UnitedHealth and Centene both pulled their outlooks this year over elevated medical spending in Medicare Advantage and the Affordable Care Act respectively. Now, cost pressures are hitting their smaller peer.
By Rebecca Pifer • July 7, 2025 -
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Historic Medicaid cuts to come as Trump signs domestic policy bill
President Donald Trump passed the GOP's tax megabill into law on Friday, setting into motion $1 trillion in Medicaid cuts despite objections from hospitals, doctors, insurers and other stakeholders in the healthcare industry.
By Emily Olsen • July 4, 2025 -
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 -
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Optum Rx slashes reauthorization requirements for more drugs
The UnitedHealth-owned pharmacy benefit manager has removed reauthorization requirements for more than 140 drugs so far this year amid what it says is a push to improve patient access to critical medications.
By Susanna Vogel • July 2, 2025 -
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Senate passes Trump’s spending bill with massive Medicaid cuts
After a marathon “vote-a-rama,” the Senate narrowly passed the legislation 51-50, with Vice President JD Vance casting the tiebreaking vote.
By Emily Olsen , Susanna Vogel • Updated July 2, 2025 -
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CMMI to add prior authorization for some Medicare services
Beginning next year, the CMS will launch an AI-powered prior authorization process for some services as it seeks to cut funding for what it deems medically unnecessary care.
By Susanna Vogel • July 1, 2025 -
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6 ways employers can lower healthcare costs in 2025
“Employers have absorbed the majority of cost increases over the past four years, and they likely cannot continue to do so,” one expert said.
By Michael Brady • July 1, 2025 -
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UnitedHealth changes leadership at care delivery unit
Patrick Conway, who recently became chief executive of the larger Optum health services division, will replace Dr. Amar Desai as CEO of Optum Health.
By Emily Olsen • June 30, 2025 -
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Supreme Court upholds ACA preventive services mandate
The high court preserved a key portion of the Affordable Care Act that requires private insurers to cover a range of preventive healthcare services without cost sharing.
By Emily Olsen • June 27, 2025 -
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Congress should reconsider breaking up pharmacy benefit managers, experts say
Many popular proposals to reform the PBM industry are missing the forest for the trees, drug market experts said in Washington, D.C. Instead, Congress should go after the root issue: the oligopoly enjoyed by the Big Three PBMs.
By Rebecca Pifer • June 27, 2025 -
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CVS Caremark to pay $95M in Medicare fraud case
A federal judge ruled in favor of a whistleblower, finding CVS’ pharmacy benefit manager Caremark overbilled Medicare for generic drugs.
By Sydney Halleman • June 26, 2025 -
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Medicaid, SNAP cuts could lead to nearly 500,000 lost healthcare jobs: report
A large portion of the 1.2 million jobs that could be lost nationwide in 2029 would come from the healthcare sector, like roles at hospitals, physician offices, pharmacies and long-term care providers.
By Emily Olsen • June 25, 2025 -
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Oz hints at impending CMS rule to force drug price transparency
The Trump administration hopes to issue a rule by the end of this year empowering regulators to “very forcefully” go after companies that don’t share information on drug costs, the CMS administrator said Tuesday.
By Rebecca Pifer • June 24, 2025 -
Rebecca Pifer/Healthcare Dive
Health insurers, nudged by Trump administration, pledge reform to prior authorization
Major insurers have agreed to six commitments that should make accessing care easier for patients while removing administrative burden on providers. But, the pledges’ voluntary nature makes compliance an open question.
By Rebecca Pifer • June 23, 2025 -
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CMS slashes ACA sign-up periods, tightens eligibility in final rule
On Friday, the Trump administration finalized a rule that’s expected to cause between 725,000 and 1.8 million people to lose ACA coverage.
By Rebecca Pifer • June 23, 2025 -
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Medicare go-broke date pushed up three years in latest trustees report
The clock is ticking to stabilize Medicare, as a key trust fund underpinning the insurance program’s hospital benefit is now set to be depleted in 2033 instead of 2036.
By Rebecca Pifer • June 20, 2025 -
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ICHRA adoption grows as Congress mulls codifying the coverage into law
Though the vast majority of individual coverage health reimbursement arrangements remain among small employers, large employers are adopting the plans at a faster clip, the HRA Council found.
By Rebecca Pifer • June 18, 2025 -
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Federal policies could reverse states’ historic coverage gains: report
The uninsurance rate for working adults fell from over 20% in 2013 to 11% in 2023. But federal policies like Medicaid cuts threaten that improvement, according to the Commonwealth Fund.
By Emily Olsen • June 18, 2025 -
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GOP Medicaid cuts would cause thousands of preventable deaths: study
Medicaid provisions in Republicans’ reconciliation megabill would lead to between 8,000 and nearly 25,000 medically preventable deaths, according to new research in the Annals of Internal Medicine.
By Rebecca Pifer • June 17, 2025 -
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Humana’s cautious defense of Medicare Advantage
At the insurer's investor day, Humana struck a middle ground in defending the importance of the privatized Medicare program — which accounts for the bulk of its revenue — while allowing that there’s room for improvement.
By Rebecca Pifer • June 17, 2025 -
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Senate Republicans propose deeper Medicaid cuts in reconciliation bill
Hospital groups slammed the Senate’s version of the GOP legislation. The upper chamber “made a bad bill worse,” said Chip Kahn, CEO of the Federation of American Hospitals.
By Emily Olsen • June 17, 2025 -
Anna Moneymaker / Staff via Getty Images
Hundreds of rural hospitals at risk if Medicaid cuts pass, Democrats say
The data released by a group of Democrat lawmakers found 338 rural hospitals were at risk of closure, conversion or service cutbacks if Republicans’ reconciliation bill becomes law.
By Emily Olsen • June 16, 2025 -
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Iowa passes law imposing tighter restrictions on PBMs
Last week, Gov. Kim Reynolds signed a law seeking to control rising prescription drug costs and protect rural pharmacies by targeting some of the drug middlemens’ most controversial practices.
By Susanna Vogel • June 16, 2025 -
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Employers eye rising costs as they assess benefit offerings: WTW
In light of financial concerns, few employers plan to expand benefit offerings this year, WTW said.
By Susanna Vogel • June 12, 2025 -
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Cigna launches new generative AI assistant for members
The health insurer is trying to improve the customer experience by connecting them with an AI bot, but analyses show generative AI can make mistakes.
By Rebecca Pifer • June 12, 2025 -
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HHS watchdog accuses CVS Medicare Advantage plan of upcoding
The vast majority of diagnoses codes that CVS subsidiary Coventry submitted to the CMS between 2018 and 2019 weren’t supported by patient documentation, the HHS Office of the Inspector General found.
By Rebecca Pifer • June 11, 2025
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