Payer: Page 6
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Crapo, Wyden to reintroduce bipartisan PBM package
Republicans and Democrats couldn’t be further apart on how to address the looming ACA affordability cliff. But there seems to be a path forward on curbing pharmacy benefit managers.
By Rebecca Pifer Parduhn • Nov. 20, 2025 -
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Employers, workers to face healthcare ‘affordability crunch,’ Mercer warns
A “sharp growth” in prescription drug spending, including pricey GLP-1 weight-loss medications, helped fuel the increase, the consulting firm said.
By Ginger Christ • Nov. 19, 2025 -
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Urban safety-net hospitals vulnerable to Medicaid cuts: analysis
Though the impact on rural facilities has received more focus from lawmakers, the majority of hospitals that are most susceptible to the funding cuts operate in urban communities, according to the report.
By Emily Olsen • Nov. 19, 2025 -
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Republican antipathy during key Senate hearing darkens outlook for ACA subsidy extension
More generous subsidies for Affordable Care Act plans have helped millions of Americans afford insurance. Chances are becoming slimmer that the assistance will survive the year.
By Rebecca Pifer Parduhn • Nov. 19, 2025 -
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UnitedHealth adds former FDA commissioner Scott Gottlieb to board
UnitedHealth declined to comment on Gottlieb’s appointment, which comes as the company works to improve its relationship with federal regulators.
By Rebecca Pifer Parduhn • Nov. 19, 2025 -
Rebecca Pifer/Healthcare Dive
Epic, Humana partner to speed patient check-in and coverage verification
The new features automatically share insurance details from more than 800,000 Medicare Advantage enrollees with providers to streamline check-in and verification.
By Emily Olsen • Nov. 18, 2025 -
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States project flat Medicaid enrollment, increased spending as cuts loom: KFF
Total spending in the safety-net insurance program is expected to grow 7.9% in fiscal year 2026, according to the survey. Meanwhile, states are facing significant federal cuts in the wake of the One Big Beautiful Bill Act.
By Emily Olsen • Nov. 18, 2025 -
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CMS issues guidance on Medicaid provider tax overhaul
The agency has started to lay out how it’ll implement restrictions on the arrangements, which are used by states to finance their share of Medicaid funding, enacted in the One Big Beautiful Bill Act.
By Emily Olsen • Nov. 17, 2025 -
Courtesy of UnitedHealth Group
Optum Health names new CEO
Krista Nelson replaces Dr. Patrick Conway, who was appointed as CEO of UnitedHealth’s healthcare delivery unit in June. Conway will stay on as CEO of the company’s broader health services division.
By Susanna Vogel • Nov. 17, 2025 -
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Medicare premiums set to rise 10% next year, CMS says
The Part B premium hike could have been worse, the Trump administration said. Still, it’s likely to pressure the pocketbooks of millions of seniors, and could drive more into Medicare Advantage plans.
By Rebecca Pifer Parduhn • Nov. 17, 2025 -
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Sponsored by ZelisHow health plans can boost Star Ratings with smarter member engagement
Struggling with Star Ratings? Discover how smarter engagement can turn scores around.
Nov. 17, 2025 -
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Historic government shutdown ends, leaving ACA subsidies in limbo
The House passed a stopgap funding bill and President Donald Trump signed it after a weeks-long impasse, reopening the government without a clear path forward on preserving enhanced subsidies for ACA plans — Democrats’ chief demand.
By Rebecca Pifer Parduhn • Nov. 13, 2025 -
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Health insurers in government programs can’t seem to turn a profit
Major payers with a presence in the ACA, Medicare or Medicaid posted an average operating margin of -1.4% in the third quarter. The market “continues to be challenging,” complicating margin recovery plans, one expert said.
By Rebecca Pifer Parduhn • Nov. 12, 2025 -
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Democrats introduce bill to repeal Medicare prior authorization pilot
Lawmakers argue the CMS innovation center pilot, which will implement AI-backed prior authorization for some services in six states, will add red tape and limit access to care.
By Emily Olsen • Nov. 10, 2025 -
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Congress inches towards ending shutdown with no extension of ACA subsidies
The Senate overcame a key procedural hurdle on Sunday after eight Democrats broke with their party to back a measure freeing the government from the longest funding lapse in history.
By Rebecca Pifer Parduhn • Nov. 10, 2025 -
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Sponsored by ZelisHow flexible technology is redefining healthcare compliance
Composable tech is transforming healthcare—faster compliance, smarter savings, scalable growth.
By Serkan Kutan, Chief Technology Officer, Price Optimization, at Zelis • Nov. 10, 2025 -
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CMMI to launch model to lower Medicaid drug spending
Under the model, set to start next year, the CMS will negotiate lower prices for Medicaid programs linked to those paid in select other countries.
By Emily Olsen • Nov. 7, 2025 -
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Novo, Lilly cut deal with Trump to lower prices of obesity drugs
The agreement will make Wegovy and Zepbound available to some Medicare enrollees for $245 per month, and starter doses of pill versions, once approved, for $149 monthly.
By Jonathan Gardner • Nov. 6, 2025 -
Alamy
Cigna’s new chief medical officer starts as other execs depart the company
Dr. Amy Flaster, Cigna Healthcare’s chief medical officer since last year, is stepping up as CMO of the whole enterprise. At the same time, Cigna’s chief health officer and a business improvement executive are hitting the road.
By Rebecca Pifer Parduhn • Nov. 6, 2025 -
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Humana confident in Medicare Advantage growth despite plan generosity muddling margin recovery
The Medicare giant likes what it’s seen in the first two weeks of open enrollment. But there are steps it can take if membership growth starts getting out of hand, executives said.
By Rebecca Pifer Parduhn • Nov. 5, 2025 -
Permission granted by Aspen Institute
Legislators object to proposed CMS payment changes for diabetes tech
In a letter to CMS Administrator Dr. Mehmet Oz, diabetes caucus leaders raised concerns that the agency’s proposals will reduce access to glucose monitors and insulin pumps.
By Elise Reuter • Nov. 4, 2025 -
Alamy
UnitedHealthcare pays Optum doctors more than other doctors: study
Researchers said the results suggest UnitedHealth may be sidestepping government rules meant to keep a lid on exorbitant payer profits. UnitedHealth said the study was “flat-out wrong.”
By Rebecca Pifer Parduhn • Nov. 4, 2025 -
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Health groups urge passage of bill to ease Medicare pay cuts for tests
More than 30 organizations, including AdvaMed and the American Clinical Laboratory Association, are pushing for a permanent legislative solution to stop looming Medicare payment cuts for diagnostic tests.
By Susan Kelly • Nov. 3, 2025 -
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Medicare finalizes controversial cut to specialty care next year
The CMS finalized the Medicare physician fee schedule for 2026 one day before the statutory deadline. It includes an overall payment hike and a few policies that are deeply unpopular with specialists.
By Rebecca Pifer Parduhn • Updated Nov. 4, 2025 -
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Federal ACA enrollment kicks off without action on subsidies
Millions of Americans are facing steep price hikes for Affordable Care Act coverage while Congress dithers over the issue. Experts say there’s not as much time to act as legislators may believe.
By Rebecca Pifer Parduhn • Nov. 1, 2025
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