Payer: Page 6

  • One person is standing behind a podium with a sign that reads "One Big Beautiful Bill Act." A handful of other people are standing around and behind the person and they are in a room with wood paneling.
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    More than half of adults worry Medicaid cuts could hurt healthcare access: KFF

    Concerns about the policies are split along party lines. Still, more than 30% of Republicans said they were concerned the cuts could negatively impact their ability to get and pay for healthcare.

    By • June 10, 2025
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    PBM lobby sues Arkansas over law requiring drug middlemen to sell pharmacies

    The Pharmaceutical Care Management Association is following in the footsteps of two of its largest members — Cigna’s Express Scripts and CVS’ Caremark — that have also sued Arkansas over its controversial law.

    By • June 10, 2025
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    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
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    Public health scholars ask HHS to reject Georgia Medicaid work requirement extension

    The American Public Health Association and dozens of other experts had harsh words for Georgia’s request to continue its controversial “Pathways to Coverage,” saying it enrolls fewer beneficiaries at a higher cost.

    By • June 6, 2025
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    Nearly 11M would become uninsured under GOP reconciliation bill: CBO

    The latest analysis from the nonpartisan budget scorekeeper found 7.8 million would lose coverage due to Medicaid cuts.

    By • June 5, 2025
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    State exchange directors urge Senate to reconsider GOP megabill, citing harm to ACA enrollees

    Seventeen states sent the letter to Senate leadership outlining how Republicans’ reconciliation legislation will kick millions off coverage, sicken risk pools and trample on state autonomy.

    By • June 5, 2025
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    Appeals court to rehear No Surprises case in bright spot for providers

    The 5th Circuit could potentially cancel out a rare win it handed the federal government late last year in litigation over the No Surprises Act.

    By • June 4, 2025
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    Amazon Pharmacy’s PillPack expands to Medicare patients

    Amazon also announced a new feature allowing customers to invite caregivers to manage medications on their behalf as the e-commerce giant builds out its Amazon Pharmacy offerings.

    By • June 4, 2025
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    HHS staffers sue over ‘hopelessly error-ridden’ layoffs

    Most of the 10,000 HHS employees let go this spring could qualify for the class, according to lawyers. It’s the latest in a string of litigation against the Trump administration for drastically downsizing the federal workforce.

    By • June 4, 2025
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    Centene sued over alleged ghost network following member’s death

    Ravi Coutinho tried to access mental healthcare he thought was covered by his Centene plan to no avail. The 36-year-old was later found dead, and his mother — who is bringing the suit — believes Centene is to blame.

    By • June 3, 2025
  • U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. testifies before the Senate Committee on Health, Education, Labor, and Pensions on Capitol Hill on May 14, 2025 in Washington, DC.
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    HHS releases more detailed 2026 budget disclosing scope of cuts

    On Friday, the HHS fleshed out a preliminary budget released in the spring and gave new details about which of its programs would be terminated if the Trump administration gets its way.

    By • June 2, 2025
  • Arkansas Gov. Sarah Huckabee Sanders wears a red dress speaking during the Republican National Convention.
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    CVS, Cigna sue Arkansas to overturn new PBM law

    The massive pharmacy middlemen contend that Arkansas’ law, which requires PBMs to divest pharmacies they own in the state, flies in the face of the Constitution and would worsen healthcare access.

    By • May 30, 2025
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    Elevance sues Georgia providers for allegedly gaming No Surprises arbitration

    Hospitalist Medicine Physicians, Sound Physicians Emergency Medicine and billing provider HaloMd allegedly filed thousands of ineligible disputes into the arbitration process, costing the insurer millions of dollars.

    By • May 29, 2025
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    GLP-1 prescriptions for weight loss are shooting up, despite obstacles

    The percentage of overweight or obese adults prescribed GLP-1s jumped by almost 587% between 2019 and 2024, according to a new Fair Health report.

    By • May 28, 2025
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    Trump administration threatens states over Medicaid coverage for undocumented immigrants

    The CMS told states it plans to go over their Medicaid spending with a fine-toothed comb to ensure federal dollars aren’t covering immigrants in the country illegally.

    By • May 28, 2025
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    Medicaid cuts could threaten healthcare access for young adults: report

    Young adults could struggle to navigate government bureaucracy and face other challenges managing work requirements or increased eligibility checks in the safety-net insurance program, the Urban Institute found.

    By • May 27, 2025
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    Trump administration updates price transparency guidance for hospitals and payers

    Federal agencies are seeking public feedback on how to improve price transparency around prescription drugs and boost hospital compliance and enforcement.

    By • May 27, 2025
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    Evernorth reaches deals with Novo Nordisk, Eli Lilly to cap GLP-1 copays

    The agreements cap patients’ monthly out-of-pocket costs for Zepbound and Wegovy at $200 and more deeply discount the drugs for Evernorth’s employer and health plan clients.

    By • May 22, 2025
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    CMS expands audits to crack down on Medicare Advantage overpayments

    The agency said it would increase the number of MA plan audits and complete its backlog of reviews by investing in technology and growing its medical coding workforce.

    By • May 22, 2025
  • Speaker Mike Johnson stands behind a podium in front of a portrait of George Washington.
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    House passes reconciliation bill with massive Medicaid cuts

    Speaker Mike Johnson negotiated a number of last-minute changes to the megabill to ensure passage, including moving up the start date for Medicaid work requirements. The House passed the bill 215-214 on Thursday morning.

    By • May 22, 2025
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    Judge denies Florida Blue’s request to bump star ratings

    The insurer sued the CMS late last year, arguing that flooding in Broward County should have qualified as an extreme and uncontrollable event relieving Florida Blue from star ratings decreases. A federal judge disagreed.

    By • May 21, 2025
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    UnitedHealth downgraded by investment banks

    TD Cowen, Raymond James and Bank of America have all downgraded UnitedHealth’s stock, citing dogged internal challenges facing the company.

    By • May 20, 2025
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    Judge shuts down drugmakers’ 340B rebate plans, for now

    A district court ruled that the HHS does have the power to review drug manufacturers’ plans to pay hospitals rebates instead of upfront discounts on 340B medications. But it left the door open to the controversial reforms.

    By • May 19, 2025
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    Sponsored by Veradigm

    How payers can drive value-based care forward

    Lead value-based care with data, tech and the Veradigm Network advantage.

    By Veradigm • May 19, 2025
  • U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. testifies before the Senate Committee on Health, Education, Labor, and Pensions on Capitol Hill on May 14, 2025 in Washington, DC.
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    RFK Jr. calls GOP Medicaid plans ‘not true cuts’

    Republicans’ plan to reduce spending on Medicaid would eliminate waste, fraud and abuse, the HHS secretary said in hearings last week. Millions could become uninsured under the proposal.

    By • May 15, 2025
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    Deep Dive

    House committees advance reconciliation text with big impacts on healthcare

    Republicans in Energy and Commerce and Ways and Means have approved their portions of President Donald Trump’s “big, beautiful bill” after marathon markups. Here’s an extensive look at what the legislation means for healthcare.

    By • May 15, 2025