Payer: Page 55
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Win McNamee / Staff via Getty Images
Biden discusses drug prices, mental health services in annual address
The president also announced a "test to treat" program that would allow people to receive a COVID-19 test at a pharmacy and immediately receive free antiviral pills, such as Pfizer's Paxlovid or Merck's molnupiravir.
By Shannon Muchmore • March 2, 2022 -
Alex Wong via Getty Images
CMS redesigns controversial Medicare direct contracting model
The decision to retain the direct contracting model — albeit with numerous changes and a new name — was met with mixed reactions from stakeholders.
By Rebecca Pifer Parduhn • Feb. 28, 2022 -
DOJ moves forward with suit to block UnitedHealth's acquisition of Change
The lawsuit alleges that if UnitedHealth acquired Change, the payer would be able to gain a competitive advantage by seeing "very competitively sensitive" data from other insurers.
By Shannon Muchmore • Feb. 25, 2022 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
FTC seeks public comments on pharmacy benefit managers' impact on patients, pharmacies
After a failed bid to launch a formal inquiry into PBMs, the FTC now says it wants to collect comments from the public to study a wide array of PBM practices.
By Samantha Liss • Feb. 25, 2022 -
Courtesy of One Medical
One Medical partnering with Connecticut health system, but stock drags on high MLR
CEO Amir Dan Rubin told analysts in a call Wednesday that COVID-19 headwinds continue, including staffing shortages, a lag in return to care and reduced revenue from testing.
By Shannon Muchmore • Feb. 24, 2022 -
Courtesy of Humana
Humana agrees to board refresh in deal with activist hedge fund
It's the latest insurer facing pressure from an activist investor group, following a shakeup at Centene.
By Samantha Liss • Feb. 23, 2022 -
Ground ambulance costs continue to soar, study finds
More ambulance trips are billing for "advanced life support," denoting a higher level of care (and reimbursement). Private insurers' payments for those trips increased 56% between 2017 and 2020, Fair Health found.
By Rebecca Pifer Parduhn • Feb. 22, 2022 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
FTC to vote on investigation into PBMs' drug pricing practices
The agency's commissioners will weigh Thursday whether to investigate PBMs and their relationship to drug prices and "practices that may disadvantage independent or specialty pharmacies," according to the meeting agenda.
By Samantha Liss • Feb. 17, 2022 -
Retrieved from FTC.
FTC fails to get enough votes to launch study into PBM practices
Numerous pharmacists urged commissioners to probe the practices of PBMs, which they allege harm their independent pharmacies and threaten to drive them out of business.
By Samantha Liss • Feb. 17, 2022 -
Molina plans steep reduction in marketplace enrollment
The payer is expected to lose two-thirds of its marketplace enrollment by the end of the year, according to executives.
By Samantha Liss • Feb. 16, 2022 -
DOJ has until Feb. 27 to sue to block UnitedHealth's $8B Change acquisition
The companies said they would give the DOJ 10 days notice before completing the merger, during which the DOJ could launch a lawsuit to block it. On Feb. 17, UnitedHealth and Change gave the regulators that notice.
By Rebecca Pifer Parduhn • Updated Feb. 22, 2022 -
Smaller rivals snap up Medicare Advantage members
MA startups were able to win market share during the most recent open enrollment period, threatening the market share of incumbents and suggesting more willingness to shop among U.S. seniors.
By Samantha Liss • Feb. 9, 2022 -
Bruce Bennett via Getty Images
Boosters and test demand — coupled with lower COVID-19 treatment costs — drove CVS profit up 33% in Q4
People flocked to get booster shots as the omicron variant drove a sharp increase in testing, boosting revenue for CVS' drugstore segment. Meanwhile, its payer arm reported lower-than-expected COVID-19 treatment costs.
By Rebecca Pifer Parduhn • Feb. 9, 2022 -
Jury trial gets underway in antitrust suit against Sutter Health
The California hospital system is accused of wielding its market power to drive up health insurance premiums for hundreds of thousands of consumers.
By Susan Kelly • Feb. 9, 2022 -
Megan Quinn/Healthcare Dive
Congress poised to address mental health crisis — including fining payers for benefit inequities
"If we're going to respond to the behavioral health issues the pandemic has made worse ... that will take legislative action," Senate health committee Chairwoman Patty Murray, D-Wash., said.
By Rebecca Pifer Parduhn • Feb. 4, 2022 -
Megan Quinn/Healthcare Dive
Senators pinpoint MA oversight, cutting drug costs to address looming Medicare insolvency
"We should be addressing this in a more serious fashion than we are," Sen. Bill Cassidy, R-La., said.
By Rebecca Pifer Parduhn • Feb. 3, 2022 -
Along with rate increase for MA plans, CMS pitches closer look at social determinants of health
Cowen analysts said the rate increase "should support another year of benefit enhancements & strong enrollment growth," and noted that in recent years the final rate has been higher than what was first proposed.
By Shannon Muchmore • Feb. 3, 2022 -
Anthem relies on flexible partner-not-build strategy in shift to value
It's a capital-efficient way to achieve growth without being pigeonholed into one approach and differs from the value-based blueprints of peers UnitedHealth and Humana, analysts said.
By Rebecca Pifer Parduhn • Feb. 2, 2022 -
Courtesy of Humana
Humana looks to cut costs, reinvest $1B into Medicare business
Part of the plan includes "optimizing" the workforce. Executives didn't clarify whether that would include layoffs.
By Samantha Liss • Feb. 2, 2022 -
Payers, researchers warn CMS proposal could cut funds to insurers enrolling high-risk consumers
Insurers are flagging concerns about changes to a CMS model aimed at encouraging more healthy consumers to sign up for coverage, while new research finds the proposal could backfire.
By Susan Kelly • Jan. 31, 2022 -
adeline kon/Healthcare Dive, data from Adeline Kon / Healthcare Dive
Healthcare trends of 2022
U.S.-based digital health startups brought in almost $30 billion in 2021, nearly doubling the total investment from the prior year. Market watchers are wary on making forecasts that 2022 will break that record, but most are optimistic.
Jan. 31, 2022 -
Retrieved from iStock.
Sponsored by VeradigmImplementing value-based care to drive success for life sciences companies
Value-focused solutions can help life sciences groups make the switch to value-based contracting.
Jan. 31, 2022 -
ACA open enrollment period drove record number of sign-ups
Expanded tax credits through the American Rescue Plan made coverage more affordable and greater outreach efforts helped accelerate enrollment, health officials said.
By Hailey Mensik • Jan. 27, 2022 -
Anthem doubles profit to $1.1B, issues conservative 2022 guidance
Membership targets for the coming year, for one, "look a shade light," one analyst noted, though Anthem said it expects COVID-19 to cause less of a headwind in 2022 than in prior years.
By Rebecca Pifer Parduhn • Jan. 26, 2022 -
Insurers falling seriously short in mental health, substance use disorder benefits, federal departments say
Though progress has been made, compliance with parity laws is still patchwork in the U.S., even as COVID-19 continues to throw disparities in health access into sharp relief.
By Rebecca Pifer Parduhn • Jan. 25, 2022
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