PacificSource exits ACA exchanges, Montana amid financial strain

High costs and other stressors have made it difficult for the regional nonprofit to continue offering coverage, the company said. About 42,000 members will be affected by PacificSource’s exits.

By Rebecca Pifer Parduhn • May 26, 2026

HHS launches AI-backed health fraud crackdown

The department will use AI to examine audits from states and other federal grant recipients, and potentially withhold funds if they aren’t able to fix errors.

By Emily Olsen • May 22, 2026

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

Hospitals sue CVS for allegedly siphoning $250M in 340B funds

Hospitals affiliated with Mount Sinai, the University of Michigan and the University of Kansas allege that CVS artificially deflated reimbursement for 340B drugs for years, causing them to lose out on savings.

By Sydney Halleman • May 22, 2026

Vertical integration doesn’t appear to lead to higher drug costs in Medicare, HHS OIG finds

However, data was limited, so it’s too early to make firm conclusions, the watchdog clarified. That didn’t stop the largest PBM lobby from jumping on the report as concrete proof that consolidation doesn’t drive up prices.

By Rebecca Pifer Parduhn • May 21, 2026

Trump administration proposes crackdown on Medicaid state-directed payments

The proposed rule codifies cuts outlined in the GOP’s “One Big Beautiful Bill,” but also takes other steps to restrict supplemental Medicaid payments. The CMS said it would save the federal government over $500 billion if finalized.

By Sydney Halleman • May 21, 2026

Lawmakers mull Medicare physician pay reform to tamp down consolidation

Physician pay hasn’t kept up with the costs of providing care, pushing independent practices to sell to health systems and likely increasing costs, witnesses said during a House subcommittee hearing.

By Emily Olsen • May 21, 2026

Providence shuts down most insurance businesses for 2027

The nonprofit giant has offered health insurance for decades. But recent challenges, including higher costs and regulatory changes, have placed Providence in an untenable position, according to the integrated system’s CEO.

By Rebecca Pifer Parduhn • May 21, 2026

ACA deductibles reach record high as membership losses slated to continue: KFF

A fuller picture is emerging of how the expiration of enhanced subsidies is affecting the Affordable Care Act exchanges and the millions of Americans who rely on them for coverage.

By Rebecca Pifer Parduhn • May 20, 2026

Senate Democrats move to roll back Medicare AI prior authorization pilot

Lawmakers introduced a resolution to end the WISeR model, which Democrats say is delaying and denying care to seniors.

By Emily Olsen • May 20, 2026

Aetna’s chief digital and technology officer on how the insurer is using AI for patient engagement

Nathan Frank discusses how the insurer is using AI to engage members, how the company thinks about risks, and the importance of monitoring the tools and soliciting feedback.

By Emily Olsen • May 19, 2026

CMS finalizes major changes to ACA exchanges, including greater access to catastrophic plans

The Trump administration continues to open the doors to the cheap, high-deductible coverage, to the worry of insurance experts and stakeholders in the healthcare industry.

By Rebecca Pifer Parduhn • May 18, 2026

Employer groups, unions urge Trump administration to reform No Surprises dispute resolution

Providers are reaping high award amounts, and arbiters have “structural conflicts of interest” that incentivize a high volume of disputes, driving up healthcare costs for employers and patients, the groups wrote.

By Emily Olsen • May 18, 2026

CMS launches initiative to speed electronic prior authorization adoption

The effort, part of the agency’s ambitious Health Tech Ecosystem, aims to accelerate the industry’s progress before requirements on electronic prior authorization go into effect next year.

By Emily Olsen • May 14, 2026

Physicians skeptical of insurer pledges to reform prior authorization: survey

Only 33% of physicians surveyed by the American Medical Association said they believed voluntary pledges made by major insurers last year to reform prior authorization would result in any meaningful difference to the industry.

By Sydney Halleman • May 14, 2026

Employers say they’re doing enough to help with medical costs, but workers disagree

The study highlights “a significant disconnect between how employers believe they are supporting employees and how employees say they feel,” Prudential Financial said.

By Ginger Christ • May 14, 2026

CMS suspends new Medicare enrollment of hospice, home health providers

The agency is halting enrollments for six months as part of the Trump administration’s broader attempt to crack down on fraud. Hospice and home health groups said they largely supported the moratorium.

By Emily Olsen • May 13, 2026

Employers say they prefer rebate-free PBM models

More than 90% of employers agreed a rebate-free approach is easier to understand and would improve drug price transparency, according to the survey conducted for Evernorth, which operates a pharmacy benefit manager.

By Emily Olsen • May 12, 2026

Optum Rx shifts to fee-based PBM model in bid to boost transparency

Clients of the drug middleman can pay monthly fees per member that aren’t linked to manufacturers’ list prices or prescription volume.

By Emily Olsen • May 12, 2026

Feds propose rule to help employers expand fertility benefit coverage

The proposal addresses a key plank in President Donald Trump’s labor agenda and would exempt fertility benefits from the requirements of some federal health coverage laws.

By Ryan Golden • May 11, 2026

MACPAC calls for increased transparency in Medicaid AI prior authorization

The influential advisory group is recommending policies to boost human oversight and visibility into how Medicaid plans are using the technology, in a bid to prevent risks like inaccuracies or data bias.

By Emily Olsen • May 11, 2026

4 questions your tech should answer to confidently navigate a risk-based future

A risk-based future is the reality for healthcare, is your organization ready to succeed?

By Cedar Gate Technologies, an IQVIA business • May 11, 2026

From hidden costs to smarter choices: Why transparency is key to lowering healthcare spend

The hidden gap driving higher healthcare costs.

May 11, 2026

GLP-1s driving healthcare cost hikes, employers say

Nearly 8 in 10 reported the expensive weight loss medications are increasing their company’s healthcare costs, according to a survey by the Business Group on Health.

By Emily Olsen • May 6, 2026

CVS hikes outlook as Aetna insurance profit rises

The healthcare giant increased its adjusted earnings guidance for 2026 by more than 4% as CVS saw “substantial improvement” in its health benefits segment, CFO Brian Newman said on an earnings call.

By Emily Olsen • May 6, 2026

Highmark Health names ex-UnitedHealth exec as COO

Heather Cianfrocco is joining the Pittsburgh-based healthcare company as its chief operating officer effective immediately.

By Rebecca Pifer Parduhn • May 5, 2026