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Alamy
Cigna’s 2026 pharmacy profits could be dampened by transition to rebate-free model
Overall, Cigna expects earnings to grow next year after posting a solid third quarter. But investments in a new PBM model and discounted contracts for some big clients could lower Express Scripts’ profitability, executives said.
By Rebecca Pifer Parduhn • Oct. 30, 2025 -
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Voters blame insurers for medical debt: poll
More than 60% of respondents said insurance companies are most at fault for medical debt, compared with just 9% who blamed hospitals, according to a survey by nonprofit Undue Medical Debt.
By Emily Olsen • Oct. 29, 2025 -
Joe Raedle via Getty Images
CVS hikes 2025 guidance despite goodwill impairment charge on healthcare delivery
The healthcare giant beat Wall Street expectations in the third quarter, but reported a net loss after recording a $5.7 billion charge linked primarily to decelerating clinic growth at Oak Street Health.
By Emily Olsen • Oct. 29, 2025 -
Alamy
Centene posts $6.6B loss on massive value writedown
The goodwill impairment charge is meant to realign Centene’s value on its own books with its value in the market, which has plummeted this year. Still, Centene upped its earnings outlook for 2025.
By Rebecca Pifer Parduhn • Oct. 29, 2025 -
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National payers OK on price transparency compliance: Turquoise Health
The company has started to score insurers on their success in making rate data available online. Large payers tend to do better than their smaller peers.
By Rebecca Pifer Parduhn • Oct. 29, 2025 -
Courtesy of UnitedHealth Group
UnitedHealth maps path back to Wall Street’s good graces
The healthcare giant beat Wall Street expectations in the third quarter and raised its 2025 earnings guidance, albeit modestly.
By Rebecca Pifer Parduhn • Oct. 28, 2025 -
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Surprise BillingHigh volume of surprise billing disputes are ineligible for arbitration, insurers allege
Plans found 39% of claims submitted to independent dispute resolution last year were actually ineligible for the process, but arbiters themselves caught only 17% of improper cases, according to AHIP and the BCBSA.
By Rebecca Pifer Parduhn • Oct. 27, 2025 -
Courtesy of Express Scripts
Cigna’s Express Scripts to transition away from rebate drug model
The massive PBM also said it will move to a cost-plus reimbursement model for in-network pharmacies. The moves come as the controversial drug middlemen attempt to lessen regulatory scrutiny.
By Rebecca Pifer Parduhn • Oct. 27, 2025 -
Alex Wong via Getty Images
CMS calls back furloughed employees to help with Medicare, ACA enrollment periods
Roughly 3,000 employees went back to work on Monday, funded by user fees as the shutdown drags into its fourth week.
By Rebecca Pifer Parduhn • Oct. 24, 2025 -
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Ballad Health sues UnitedHealth for Medicare Advantage ‘manipulation’
The Appalachian system said it is turning to the courts as a last resort after failing to resolve years of payment and patient care issues.
By Rebecca Pifer Parduhn • Oct. 24, 2025 -
Permission granted by Optum
Optum taps its second CFO in 6 months
It’s the latest management shakeup at UnitedHealth as the company attempts to shore up investor confidence.
By Rebecca Pifer Parduhn • Oct. 24, 2025 -
Alamy
Molina slashes 2025 profit guidance again on ACA woes
Molina’s profit in the third quarter plummeted as the insurer was hit with an increase in marketplace medical costs that one analyst called “staggering.”
By Rebecca Pifer Parduhn • Oct. 23, 2025 -
Courtesy of HLTH 2025
HLTH25Top RFK aide lashes out against healthcare industry for profiting off of illness
Calley Means stopped short of accusing hospitals, insurers and drug companies of actively working to keep Americans sick, but said it was an "economic fact" that the companies benefit financially when people are ill.
By Susanna Vogel • Oct. 22, 2025 -
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‘A quiet alarm bell going off’: Job-based family coverage hits $27K annually
Premium increases are outpacing wage growth and general inflation at a time of intense focus on healthcare affordability, according to new research from KFF.
By Rebecca Pifer Parduhn • Oct. 22, 2025 -
Permission granted by Optum
HLTH25
Optum launches AI system to speed medical claims
Optum Real allows providers to receive information about patients’ health benefits in real time, the company said.
By Emily Olsen • Oct. 22, 2025 -
Emily Olsen/Healthcare Dive/Healthcare Dive
HLTH25Medical billing firm Cedar launches Medicaid enrollment tool as cuts loom
The tool, which aims to help patients enroll in and maintain coverage, comes as healthcare braces for major cuts to the safety-net insurance program.
By Emily Olsen • Oct. 21, 2025 -
Alamy
Elevance outperforms in third quarter but warns of Medicaid challenges
The Indianapolis-based company is the first major insurer to release earnings this cycle. Elevance did well in the quarter, but hinted that profits could be constrained in 2026.
By Rebecca Pifer Parduhn • Oct. 21, 2025 -
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Opinion
Beyond one-size-fits-all: How ICHRA empowers employees and employers
ICHRA plans, a nascent form of health coverage, are gaining traction, argues an executive of Centene subsidiary Ambetter Health.
By Alan Silver • Oct. 16, 2025 -
Rebecca Pifer/Healthcare Dive
Oz reiterates need to improve Medicare Advantage payment accuracy
The CMS administrator’s comments at an industry event in D.C. reflect the difficult tightrope regulators in the Trump administration walk as they pursue MA reform.
By Rebecca Pifer Parduhn • Oct. 15, 2025 -
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California passes laws targeting PBMs, private equity
Gov. Gavin Newsom signed an array of healthcare bills into law last week that crack down on pharmacy benefit managers and beef up the review process for deals involving private equity firms.
By Susanna Vogel • Oct. 15, 2025 -
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Healthcare AI investment focused on profit margins, ROI: report
As providers and payers navigate an increasingly challenging financial environment, executives are targeting AI tools that show a clear return on investment, according to a report by Klas Research and Bain & Company.
By Emily Olsen • Oct. 15, 2025 -
Andrew Harnik via Getty Images
Senate Finance Committee probes Medicaid contractors over faulty systems
Top Democrats are airing related concerns that the IT chassis underpinning states’ Medicaid operations may not be robust enough to withstand the added pressure from looming work requirements.
By Rebecca Pifer Parduhn • Oct. 15, 2025 -
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Humana loses Medicare Advantage stars lawsuit for a second time
A federal judge ruled in favor of the CMS on Tuesday, one day before the start of Medicare open enrollment. A spokesperson for Humana said the insurer is considering “all available legal options.”
By Rebecca Pifer Parduhn • Oct. 14, 2025 -
Andrew Harnik / Staff via Getty Images
Top Democrat questions Medicare Advantage insurers on AI claims denials
The letter from Sen. Richard Blumenthal comes one year after a Senate investigation criticized major MA payers for using predictive technology to deny post-acute care.
By Emily Olsen • Oct. 14, 2025 -
ShutterStock/452725810
Sponsored by West MonroeNavigating the perfect storm: Cost pressures and regulatory challenges
Healthcare’s perfect storm: soaring costs, shifting regs and AI’s role in survival.
By Esteban López, MD, MBA Partner, Healthcare • Oct. 13, 2025
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