Payer: Page

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    Trump signs funding bill with PBM reforms, hospital-at-home and telehealth extensions

    The funding package ends a partial government shutdown and enacts several healthcare policies, including preserving telehealth flexibilities in Medicare through 2027.

    By • Feb. 4, 2026
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    Genetic testing takes greater share of Medicare Part B test spending: OIG

    Spending on the tests, which analyze genetic material from both people and pathogens, rose 20% year over year in 2024, the analysis found.

    By Susan Kelly • Feb. 4, 2026
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    Yujin Kim/Healthcare Dive
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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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    Alex Wong via Getty Images
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    CMS presses ahead on accelerated Medicare Advantage audits

    The agency quietly released a memo updating MA plans on how it’s approaching risk adjustment data validation audits after a Texas judge’s ruling last year threw the expanded reviews into doubt.

    By • Feb. 4, 2026
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    Alamy
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    Prices rise at surgery centers acquired by Optum: study

    The full financial impact of the price hikes could exceed $67 million each year in two dozen markets, according to the new study published in Health Affairs.

    By • Feb. 3, 2026
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    Medicare Advantage prior authorization requests rise in 2024: report

    Nearly 53 million prior authorization requests were sent to insurers in 2024, compared with nearly 50 million in the prior year, according to KFF. Almost 8% of those requests were partially or fully denied.

    By • Feb. 3, 2026
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    Humana deploys AI support tool for call centers

    Agent Assist, developed with Google Cloud, summarizes conversations between workers and beneficiaries while highlighting relevant information, like enrollees’ benefit and eligibility details.

    By • Feb. 3, 2026
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    Win McNamee via Getty Images
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    Telehealth flexibilities, hospital-at-home waivers lapse amid partial government shutdown

    The Senate passed a spending package Friday, but the measure is still awaiting House approval. House Speaker Mike Johnson said the partial shutdown should be brief.

    By • Feb. 2, 2026
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    Sponsored by Elavon

    As self-pay increases, healthcare leaders look to retail for inspiration

    Rising costs, low reimbursement, and staffing shortages challenge small medical practices. Learning from the retail industry can help them stay profitable.

    Feb. 2, 2026
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    CMS finalizes rule cracking down on Medicaid provider taxes

    The rule puts limits on states levying higher taxes on Medicaid businesses. The CMS argues the tax arrangements allow states to shift costs onto the federal government, but providers say they’re integral for covering the cost of care.

    By • Jan. 30, 2026
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    Healthcare industry outlook for 2026: Providers, insurers, IT companies look to stability

    Companies are hoping to reshore finances and double down on efficiency initiatives this year as several policy sea changes threaten to upend the industry.

    By Healthcare Dive staff • Jan. 30, 2026
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    Labor Department wants to strong-arm PBMs into being more transparent with employers

    The DOL proposed a rule that would force pharmacy benefit managers to share a broad range of pricing and compensation information with their employer clients, calling it the most significant proposed PBM reform in decades.

    By • Jan. 30, 2026
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    Opinion

    The healthcare claims system is ready for transformation. Here are 5 ways to prepare in 2026.

    Artificial intelligence could rework the claims and reimbursement process, allowing faster decision-making, reduced errors and billions in savings, according to an Optum executive.

    By Puneet Maheshwari • Jan. 29, 2026
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    Medicaid contractors strike deals with CMS to help states execute work requirements

    Ten Medicaid systems vendors have agreed to provide low- or no-cost services to states over the next two years. The Trump administration said the agreements would save $600 million.

    By • Jan. 29, 2026
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    ACA enrollment backslides to 23M in 2026

    That’s down 5% from last year. But it’s not the nosedive some market watchers predicted, and a handful of states — notably, Texas — saw robust growth.

    By • Jan. 28, 2026
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    Deep Dive

    Health insurers brace for impact in 2026

    Profits will start to tick up after reaching trough levels. Washington will play nice. M&A and AI adoption will accelerate. We asked experts to look into their crystal balls on what the coming year means for a beleaguered industry.

    By • Jan. 28, 2026
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    Alamy
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    Elevance expects lower revenue, earnings, membership in 2026

    This year should see improvements in Medicare Advantage and Affordable Care Act plans but continued pressure in Medicaid, Elevance executives warned investors.

    By • Jan. 28, 2026
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    CMS official defends flat Medicare Advantage rate proposal for 2027

    Medicare director Chris Klomp said the Trump administration is “massively” in support of MA as health insurers cry foul over the meager rate update.

    By • Jan. 27, 2026
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    Alex Wong via Getty Images
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    CMS proposes excluding chart reviews from MA risk scoring in 2027 payment rule

    The proposal would eliminate the financial motivation insurers have to mine their members’ charts for additional diagnoses. Regulators also proposed a flat rate update for 2027, prompting anger from insurers.

    By • Jan. 27, 2026
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    Courtesy of UnitedHealth Group
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    UnitedHealth revenue climbs in 2025, though profit continues to fall

    The healthcare behemoth posted its lowest profits since 2018 last year, largely thanks to continued Medicare Advantage challenges. Executives warned how regulators’ “disappointing” rate update might further contract MA.

    By • Jan. 27, 2026
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    Surprise Billing

    No Surprises disputes increasing even as arbiters catch up, CMS says

    The agency released new data on independent dispute resolution in the first half of 2025. Roughly 1.2 million cases were filed in that period, mostly by the same private equity-backed providers.

    By • Jan. 26, 2026
  • A brick wall with a red CVS Pharmacy sign.
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    CVS accused of shutting out rival pharmacy hubs in House Judiciary investigation

    The company’s massive pharmacy benefit manager changed its rules and weaponized audits to ensure independent pharmacies couldn’t work with competing pharmacy service companies, House Republicans said.

    By • Jan. 26, 2026
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    istockphoto.com/PixelsEffect

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    Sponsored by CVS Caremark

    The case for transparent pricing: Making pharmacy benefits work for health plans

    CVS Caremark TrueCost® is the industry’s first pricing model that gives insight into drug-level costs.

    By CVS Caremark • Jan. 26, 2026
  • Boxes of the diabetes drug Ozempic rest on a pharmacy counter
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    Why cover GLP-1s? They’ll lower employer healthcare costs, study says

    While the medications may be pricey, a multi-year study by Aon found consistent use correlates with lower medical cost growth and fewer hospitalizations for cardiovascular events.

    By Caroline Colvin • Jan. 23, 2026
  • Six people in business clothes sit behind a dias in a congressional room.
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    Rebecca Pifer Parduhn/Healthcare Dive
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    Insurance CEOs’ no good, very bad day on the Hill

    The chief executives of UnitedHealth, CVS, Cigna and Elevance were pilloried for care denials, vertical consolidation and sky-high executive compensation during two House hearings Thursday.

    By • Jan. 23, 2026
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    Express Scripts considering settlement in FTC insulin price lawsuit

    The antitrust agency paused its lawsuit against the pharmacy benefit manager while the two discuss a proposed consent agreement.

    By • Jan. 23, 2026