CVS to jump back into individual ACA markets in 2022

The health giant has yet to disclose specific geographies or the cost of the plans, with newly installed CEO Karen Lynch telling investors Tuesday to expect more details in the second quarter.

By Rebecca Pifer • Feb. 16, 2021

Molina expects utilization to remain depressed in 2021

Looking ahead, executives seemed cautiously optimistic for this year but noted headwinds from the COVID-19 pandemic will persist. Bright spots for the payer include the recently announced ACA special enrollment period.

By Samantha Liss • Feb. 11, 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

As COVID-19 becomes a business, vaccine makers confront thorny pricing questions

Yearly vaccinations could be required after the pandemic ebbs. Will drugmakers change how they approach pricing their shots?

By Jonathan Gardner • Feb. 10, 2021

Medicare DME competitive bidding in doubt after failed round

Cowen analysts said a recent report found steep rate hikes, leading them to conclude the program is no longer such a big threat to companies like Baxter, ResMed and Philips.

By Nick Paul Taylor • Feb. 10, 2021

Centene to ax 3,000 jobs as run of profitable quarters ends

After months of benefiting from deferred care like many other insurers, Centene reported a loss in the fourth quarter in part due to higher COVID-19 testing and treatment costs.

By Samantha Liss • Feb. 9, 2021

Oklahoma selects 4 private payers to manage Medicaid for $2B, faces legal suit

The state maintains the switch will improve costs while maintaining access, but the move to cede Medicaid control to for-profit entities is highly controversial.

By Rebecca Pifer • Feb. 9, 2021

Fitch: Biden's healthcare plans could boost nonprofit hospitals

The ratings agency cited administration plans to bolster the Affordable Care Act, which could reverse the increased number of uninsured people, as among the factors driving brighter prospects.

By Ron Shinkman • Feb. 4, 2021

Cigna's COVID-19 costs outweighed deferred care savings for first time in Q4

CEO David Cordani told investors he expects 2021 to be a "year of transition" as coronavirus vaccine rollouts will "continue to tax an already overburdened healthcare system."

By Shannon Muchmore • Feb. 4, 2021

UnitedHealth CEO Dave Wichmann steps down, replaced by Optum head Andrew Witty

Wichmann's retirement ends his relatively short tenure at the diversified healthcare giant, and results in a leadership shakeup with Witty immediately taking the reins.

By Rebecca Pifer • Feb. 4, 2021

Medicare buy-in for older adults could cut health costs, increase coverage value: Urban Institute

A Medicare buy-in is not a specific prong of President Joe Biden's health policy agenda, but there are currently two proposals in Congress designed to build upon the ACA.

By Rebecca Pifer • Feb. 3, 2021

Humana posts Q4 loss after uptick in COVID-19 care, tests

The payer's executives said depressed utilization last year created unique challenges for 2021, particularly in the Medicare book of business.

By Samantha Liss • Feb. 3, 2021

Anthem to acquire largest Medicare Advantage plan in Puerto Rico

The deal also nets the insurer the second-largest Medicaid plan there and a network of specialized clinics.

By Samantha Liss • Feb. 2, 2021

Payers welcome reopening of ACA marketplaces

Healthcare.gov will be open for a special enrollment period from Feb. 15 through May 15, though advocates say robust outreach and marketing efforts need to be coupled with the move.

By Samantha Liss • Jan. 28, 2021

FDA approves first-of-its-kind lupus drug

Lupkynis, the first oral drug approved for lupus nephritis, comes with a high list price. Its developer, Aurinia Pharmaceuticals, expects average net revenue of roughly $65,000 per patient per year.

By Jacob Bell • Jan. 27, 2021

Anthem cuts 2021 outlook, as Q4 profits fall 40% on care resurgence

This year "presents its own unique set of business challenges," CFO John Gallina told investors. "While much has changed, it is clear we are still in the depths of a pandemic."

By Rebecca Pifer • Jan. 27, 2021

Biden to create new enrollment period for ACA exchanges

While most state-based exchanges created special enrollment periods earlier in the COVID-19 pandemic, CMS under former President Donald Trump resisted calls to do so as his administration fought the landmark law in the courts.

By Shannon Muchmore • Jan. 26, 2021

ACLA seeks lab reimbursement changes as need for COVID-19 testing surges

Julie Khani, president of the American Clinical Laboratory Association, which includes Quest and LabCorp, called for eliminating testing coverage gaps and clarifications around what tests are paid for by insurers.

By Greg Slabodkin • Jan. 25, 2021

4 key trends for payers and providers in 2021

The COVID-19 crisis has led some providers to inquire about partnering or acquiring insurance assets as the pandemic exposed the risk of relying on fee-for-service models.

By Samantha Liss • Jan. 22, 2021

CMS expands transcatheter mitral coverage, boosting Abbott's MitraClip device

Wall Street analysts said the national coverage determination could triple the patient base eligible for the company's device that repairs leaky heart valves, adding fuel to a growing and under-penetrated market.

By Ricky Zipp • Jan. 22, 2021

UnitedHealth returns to normal care levels in Q4, posts $15B in profit for 2020

The health behemoth beat Wall Street forecasts for both earnings and revenue in the fourth quarter as care consumption and prescriptions returned to more typical levels despite fears of renewed deferrals as COVID-19 cases surge.

By Rebecca Pifer • Jan. 20, 2021

How Biden might shore up the Affordable Care Act

After four years of peeling away by the Trump administration, some parts will be easier to put back together than others.

By Hailey Mensik • Jan. 20, 2021

Biden faces many healthcare challenges as he takes the helm at an unprecedented time

The former senator and vice president has been sworn in as the 46th president of the United States while the country grapples with one of the biggest health crises in its history.

Jan. 20, 2021

CMS rejects 1st colorectal cancer blood test, tweaks path for Exact, Guardant and others

The agency has removed one of the criteria a test needs to meet to secure Medicare coverage but still shunned Epigenomics' Epi proColon diagnostic.

By Nick Paul Taylor • Jan. 20, 2021

CMS finalizes prior authorization rule payers slam as 'half-baked'

Insurers face the biggest impact from the rule. America's Health Insurance Plans blasted it as "a series of empty promises" and "shabbily and hastily constructed."

By Rebecca Pifer • Jan. 15, 2021

'Really difficult nut to crack': MedPAC torn over telehealth regs post-COVID-19

Members were wary of making any concrete near-term policy changes, suggesting instead industry be allowed to test drive new telehealth regulations after the pandemic without baking them in permanently. 

By Rebecca Pifer • Jan. 15, 2021