Payer: Page 73
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In win for big payers, appeals court sides with HHS in risk adjustment case
AHIP and the Blues argued it would be inconceivable to come up with an entirely new formula for the payments created under the Affordable Care Act.
By Samantha Liss • Jan. 3, 2020 -
Pfizer, AbbVie and Gilead among drugmakers boosting prices to start 2020
List prices rose on some of the top-selling medicines in the U.S., including Humira, Opdivo, Prevnar 13 and Biktarvy.
By Andrew Dunn • Jan. 2, 2020 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/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 -
ACA 2020 enrollment stable but dips slightly
CMS attributed the decline to a few factors, including a strong economy that may have moved more people into job-based coverage and states expanding Medicaid eligibility.
By Ron Shinkman • Dec. 23, 2019 -
Sutter to pay $575M, change contracting practices in antitrust settlement
Pending approval, the deal bars the dominant Northern California system from using all-or-nothing contracts and stops certain bundling practices.
By Shannon Muchmore • Dec. 20, 2019 -
MA value-based plan enrollment tripling for 2020
CMS also moved to fold hospice care into Medicare Advantage, a cost-cutting step industry has expected for a while.
By Rebecca Pifer • Dec. 20, 2019 -
With ACA ruling, payers get unexpected short-term reprieve
Analysts say Wednesday's appeals court decision finding the Affordable Care Act's individual mandate unconstitutional is not the worst thing that could have happened for payers — for now.
By Rebecca Pifer • Dec. 19, 2019 -
Trump administration lays out plans to import drugs from abroad
But it's not clear how effective importation would be at achieving the administration's goal of reducing drug prices. High-cost drugs like biologics, for example, are excluded from one of the two proposals.
By Ned Pagliarulo • Dec. 18, 2019 -
Providers push back on PhRMA report highlighting 340B program costs
American Hospital Association executive vice president Tom Nickels blasted a new drugmaker-funded study as an "obvious attempt to divert attention away from a problem of their own making: skyrocketing drug prices."
By Rebecca Pifer • Dec. 18, 2019 -
Judge refuses to strike down 2020 site-neutral plan — but chides CMS
The federal judge said she lacks jurisdiction to strike down a policy yet to go into effect, but noted the agency's plans for next year disregard her earlier ruling.
By Samantha Liss • Dec. 17, 2019 -
Bruce Bennett via Getty Images
CVS long-term care pharmacy sued by DOJ over fraudulent prescribing practices
The suit is by no means the first time the subsidiary, acquired in 2015 for about $12.7 billion, has been under the federal microscope for fraud.
By Rebecca Pifer • Dec. 17, 2019 -
CMS wants to overhaul how organs are procured in the US
The agency estimates if all procurement groups met both the new donation and transplantation rate measures, the number of yearly transplants would shoot up more than 15% by 2026.
By Rebecca Pifer • Dec. 17, 2019 -
ACA taxes repealed in year-end spending legislation, with no surprise billing ban
Lawmakers insist a ban on surprise billing will be a top legislative priority for next year, but the spending package does not touch on the issue.
By David Lim • Updated Dec. 23, 2019 -
Culling surprise billing would save $40B annually, Health Affairs study finds
The research also found that out-of-network billing was most common at for-profit hospitals and in areas with highly concentrated provider and payer markets.
By Shannon Muchmore • Dec. 16, 2019 -
BCBS of Michigan cuts new value payment deal with 7 major systems
The model will apply to roughly 30% of the payer's total commercial and Medicare Advantage market. Health systems that have signed on include Ascension Michigan, Henry Ford Health System and Trinity Health.
By Samantha Liss • Dec. 16, 2019 -
Humana to acquire hospice pharmacy, PBM Enclara
The Louisville, Kentucky-based payer is looking to round out its pharmacy offerings for high-need patients.
By Rebecca Pifer • Dec. 16, 2019 -
HHS watchdog accuses MA plans of inflating payments by nearly $7B annually
The apparent overpayments are tied to payers tacking on new diagnosis codes as part of a review of existing medical charts, a practice CMS is encouraged to watch more closely.
By Ron Shinkman • Dec. 13, 2019 -
Livongo, Propeller, Omada tapped for Express Scripts digital health formulary
The PBM presented the formulary as a way for health plans and employers to access digital health products that have been vetted for effectiveness, security and value.
By Nick Paul Taylor • Dec. 13, 2019 -
Samantha Liss/Healthcare Dive
Centene quietly lobbying Congress to let states partially expand Medicaid
Centene wants to lower the eligibility on Medicaid expansion populations from 138% to 100% of the federal poverty level, ultimately pushing more people into the ACA exchanges.
By Samantha Liss • Dec. 12, 2019 -
Amid legal roadblocks, CMS clears South Carolina Medicaid work mandates
The administration has approved work requirements in ten states so far, though three (New Hampshire, Kentucky and Arkansas) have seen their programs struck down by a federal judge.
By Rebecca Pifer • Dec. 12, 2019 -
Getty / Edited by BioPharma Dive
Value-based pricing for gene therapy? Maybe not ready for hemophilia
Small patient population plus large potential savings could make blood clotting gene therapies an easier sell to payers, biotech execs say.
By Jonathan Gardner • Dec. 12, 2019 -
CVS launches precision medicine program for oncology
Executives have teased a cancer care pilot for much of this year as they look for ways to capitalize on overlap between retail locations and Aetna.
By Rebecca Pifer • Dec. 12, 2019 -
Health insurers stable, M&A seen diminishing in 2020: Fitch
Despite a projected increase in the growth of U.S. health spending, the ratings agency expects insurers to deliver healthy operating results including improved medical loss ratios for 2020.
By Samantha Liss • Dec. 11, 2019 -
Amazon's PillPack inks 1st digital pact with payer in BCBS Massachusetts
The Blues plan will target the offering to the 12% of its beneficiaries that take five or more maintenance medications, and the 43% that take between two and four, a spokesperson told Healthcare Dive.
By Rebecca Pifer • Dec. 11, 2019 -
Kaiser interim chief Greg Adams named full-time CEO
Adams has been at the nonprofit for over two decades and previously served as a group president overseeing hospital and health plan operations, including Kaiser's Medicare care delivery strategy.
By Rebecca Pifer • Dec. 11, 2019 -
Few Medicare Advantage plans add new benefits for serious illness
Starting this year, CMS gave the plans flexibility to offer more benefits for nonmedical services like home-based palliative care, adult daycare services, bathroom safety devices and modifications.
By Linda Wilson • Dec. 11, 2019
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