Congress: Target the middlemen who drive up drug costs

"The PBM market lacks the three elements essential for competition — choice, transparency and a lack of conflict of interest," antitrust attorney and former FTC policy director David Balto argues.

By David Balto • Nov. 15, 2021

Biogen's pricey Alzheimer's drug contributes to major Medicare premium hikes

The 15% jump in Part B premiums for 2022 is a case study in how just one expensive medication can affect the spending of millions in the U.S.

By Rebecca Pifer • Nov. 15, 2021

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

Zelis helps address new NSA and TiC regulations

Learn more about innovative solutions that can help you comply with new regulations.

Nov. 15, 2021

Family premiums rise as employers boost virtual, mental health benefits, KFF finds

About half of employers with at least 200 workers reported healthcare utilization among their plan enrollees was in line with expectations for the most recent quarter, while 32% said it was below estimates.

By Hailey Mensik • Nov. 11, 2021

Anthem plans to buy Integra Managed Care in New York

The acquisition expands the payer's Medicaid business, a service line that has experienced major growth over the past year.

By Samantha Liss • Nov. 10, 2021

Health centers raise alarm about rolling back Medicaid coverage post-public health emergency

The clinics are worried about people with Medicaid coverage being deemed ineligible and losing insurance once states revert back to pre-pandemic Medicaid policies and eligibility, a new survey found.

By Rebecca Pifer • Nov. 10, 2021

Oak Street faces DOJ inquiry into third-party marketing, transportation relationships

Analysts said the inquiry, while in early stages, could pressure the company's stock. "This creates a new potential risk factor that we are unlikely to get clarity on for some time," SVB Leerink analyst Whit Mayo said.

By Rebecca Pifer • Nov. 9, 2021

Kaiser's operating margin dwindles as COVID-19 expenses, labor costs rise

Along with ongoing pandemic stresses, the California nonprofit is facing rising expenses amid intense workforce pressure as it faces the start of a major strike next week.

By Rebecca Pifer • Nov. 8, 2021

Insurer profitability remained strong in Q3 despite unexpectedly high COVID-19 costs

For most payers, higher-than-expected coronavirus costs were offset by patients continuing to delay nonessential medical care.

Nov. 5, 2021

Cigna reports special enrollment period led to bump in medical claims, still posts $1.6B profit

Analysts characterized the third quarter results as mixed, even as the payer hiked its forecast for the remainder of the year.

By Samantha Liss • Nov. 4, 2021

Controversial UnitedHealth-Change tie-up gets new deadline for DOJ review

Consummation of UnitedHealth's $13 billion Change acquisition is now teed up for February at the earliest, though the deal could close even sooner if the DOJ unexpectedly drops its investigation — or later, if the agency challenges.

By Rebecca Pifer • Nov. 4, 2021

Humana cuts outlook after delta surge raises utilization expectations

Hospitalization trends were on par with January 2021, the height of the pandemic. As a result, Humana expects utilization to run higher than its original forecast, cutting into earnings expectations for the full year.

By Samantha Liss • Nov. 3, 2021

CMS finalizes plans to hike price transparency penalties, extend telehealth flexibilities

The agency is also moving forward with a plan to stop the elimination of the Medicare inpatient-only list, which is a win for hospitals.

By Shannon Muchmore • Nov. 3, 2021

COVID-19 medical costs drag Aetna's commercial business, but CVS still posts $1.6B in Q3 profit

Though the pandemic continues to stress CVS' payer segment, drugstores continue to benefit from COVID-19 testing and vaccinations, particularly as a greater number of employers begin to mandate the shots.

By Rebecca Pifer • Nov. 3, 2021

Outset nabs first CMS home dialysis add-on payment, setting up fight with Fresenius

The company, whose application was rejected last year, persuaded the Medicare agency its portable dialysis machine is a "substantial clinical improvement" over the incumbent home-use hemodialysis product.

By Nick Paul Taylor • Nov. 3, 2021

Why are women more likely to use telehealth?

As Washington mulls over telehealth regulations post-COVID-19, it's important not to roll back access in a way that could disproportionately affect women, experts say.

By Rebecca Pifer • Nov. 2, 2021

Federal data shows ACA, Medicaid coverage kept uninsured rate steady as open enrollment kicks off

And the numbers suggest ACA and Medicaid enrollment may be continuing the momentum notched last year as consumers turned to the programs in droves after losing job-based coverage.

By Rebecca Pifer • Nov. 1, 2021

What elective healthcare can teach us about the future of patient experience

A new report exploring how elective procedure patients think and feel can give us insight into the changes that providers and networks must make to ensure their patients feel connected during each phase of their journey. 

Nov. 1, 2021

Delta surge weighs on Molina's Q3 earnings, but membership up 20%

Despite pandemic pressure, the insurer largely beat Wall Street expectations, and Jefferies analysts said the company delivered "solid overall results."

By Samantha Liss • Oct. 28, 2021

A look at Teladoc's primary care strategy from its head of US group health

In an interview, Kelly Bliss teased upcoming clients for a new virtual-first primary care product and parsed out Teladoc's growth strategies for 2022 and beyond.

By Rebecca Pifer • Oct. 27, 2021

Centene looks to sell non-core assets, bounces back from Q2 loss

The insurer rebounded in the third quarter as patient utilization returned to more normal levels and revenue increased 11% year over year.

By Samantha Liss • Oct. 26, 2021

Cigna expands telehealth benefits for employer-covered lives, including new virtual-first plan

The virtual-first plans will initially be available to large, self-insured employers, though the insurer is looking to expand to smaller sized and fully insured clients over time.

By Rebecca Pifer • Oct. 26, 2021

Large purchaser coalition PBGH forms new venture to lower employer health costs, starting with PBM launch

Emsana is the latest independent venture from employer interests looking to disrupt the healthcare industry, a task easier said than done.

By Rebecca Pifer • Oct. 25, 2021

CMMI wants every Medicare beneficiary in an accountable care plan by 2030

Officials acknowledged provider concerns that current models are too burdensome and benchmarks too complex, which the innovation center aims to fix.

By Hailey Mensik • Oct. 21, 2021

Anthem again hikes outlook for 2021 after Q3 medical costs beat expectations

Medical costs came in below projections despite the wave of COVID-19 hospitalizations and cases that were fueled by the delta variant during the quarter.

By Samantha Liss • Oct. 20, 2021