Trump admin to allow Medicaid caps, but legal fight likely as providers protest

Providers were quick to attack the highly anticipated plan giving states the option of accepting block grants for payment in the safety-net program, choosing between a per-enrollee or total coverage budget.

By Rebecca Pifer Parduhn • Updated Jan. 30, 2020

Anthem beats earnings estimates but MLR disappoints

Operating revenue for the payer last year grew nearly 13% year over year to just above $103 billion. For the fourth quarter, it was up 16.4% to $27.1 billion, slightly above Wall Street expectations.

By Shannon Muchmore • Jan. 29, 2020

CMS widens NGS test coverage for inherited breast, ovarian cancers

While the agency declined to expand coverage beyond breast and ovarian, local Medicare contractors can make coverage determinations with other germline cancer diagnoses and on tests that have not been OK'd by FDA.

By Maria Rachal • Jan. 29, 2020

Pfizer poised to launch 3 biosimilars in coming months

The big pharma company, which has criticized others for stifling the U.S. biosimilars market, could have three cancer copycats on the market in the next three months.

By Jacob Bell • Jan. 29, 2020

ACA slashed uninsured rate, but number who can't afford care still rising

Between 1998 and 2017, the proportion of the U.S. population unable to see a doctor due to the associated costs of doing so rose from 11.4% to 15.7%, according to a new JAMA Internal Medicine study.

By Ron Shinkman • Jan. 26, 2020

Blue Cross Blue Shield partners with Civica on generic drug mission

The Blue Cross Blue Shield Association, along with 18 affiliate companies, will invest $55 million to create a new unit of the generic drug company.

By Kristin Jensen • Jan. 23, 2020

New conservative faction to lobby against benchmark surprise billing fix

The argument against a benchmark rate is popular among provider lobbies, which have spent millions to oppose such proposals — including White House-backed legislation from Senate and House heavyweights.

By Rebecca Pifer Parduhn • Jan. 22, 2020

Centene closes $17B acquisition of WellCare

The companies said Thursday morning the deal was complete and WellCare common stock would cease trading at the end of the day.

By Shannon Muchmore • Updated Jan. 23, 2020

UnitedHealth, Humana among Medicaid contracts nixed in Louisiana after protest

The decision came in response to appeals filed by Centene and Aetna, which were denied new contracts. The state will now redo the bidding process.

By Hailey Mensik • Jan. 22, 2020

Tenet, CVS and Cigna lead Healthcare Dive's JPM20 coverage

Molina and Centene also touted their organic growth potential at the annual investor conference drawing some of the biggest industry names.

Jan. 17, 2020

FTC commissioner pledges hard line on hospital mergers

Lobbyists and legislators also spoke at a Council for Affordable Health Coverage forum, noting a surprise billing ban is still on the table for Congress despite disagreements over the policy to achieve it.

By Shannon Muchmore • Jan. 17, 2020

Key 2020 trends for payers and providers

No matter who wins the White House come November, healthcare experts say the push to reimburse providers for value and the aim for greater transparency surrounding prices will keep moving ahead.

By Samantha Liss • Jan. 17, 2020

MedPAC finds 340B effect on pricing 'modest,' going against pharma critique

The commission's report provides some new ammunition in the ongoing battle between pharmaceutical companies and nonprofit disproportionate share hospitals over the future of the 340B drug discount program.

By Rebecca Pifer Parduhn • Jan. 17, 2020

CVS, Cigna execs tell JPM20 they're ready for a contentious election year

The payer officials took to the stage at the annual investor conference in San Francisco, speaking on the future of M&A and reflecting on what's sure to be a year focused on policy and politics.

By Rebecca Pifer Parduhn , Shannon Muchmore • Jan. 15, 2020

Hospitals, insurers urge Supreme Court to hear ACA case to avert havoc

Lobbying groups said the case could take years to play out without the high court stepping in to hear arguments now.

By Samantha Liss • Jan. 15, 2020

UnitedHealth reports nearly $14B in 2019 profit

The company beat forecasts on Q4 earnings, though revenues of $60.9 billion were slightly lower than Wall Street expectations.

By Rebecca Pifer Parduhn • Jan. 15, 2020

LabCorp, Quest push for M&A-driven growth despite difficulties closing deals

"It’s still a very fragmented marketplace. There’s plenty of opportunity for us to consolidate it," Quest CEO Steve Rusckowski said.

By Nick Paul Taylor • Jan. 15, 2020

Will more employers get off the healthcare bench in 2020?

"At the end of the day, employers have to put their hands on the steering wheel as purchasers of healthcare," Suzanne Delbanco, executive director of Catalyst for Payment Reform, said.

By Rebecca Pifer Parduhn • Jan. 14, 2020

Cigna links up with upstart Oscar for small business health insurance

New York City-based Oscar has won some praise for customer service, but also criticism for small provider networks.

By Rebecca Pifer Parduhn • Jan. 14, 2020

JPM20: Rivals Molina, Centene pitch investors on organic growth

"I'll repeat this countless numbers of times this afternoon: Our first priority is to grow the business organically. It is the most efficient use of capital," Molina CEO Joseph Zubretsky said as the annual investor conference kicked off.

By Samantha Liss • Jan. 14, 2020

Supreme Court to take on PBM rate regulation

A federal appeals court previously ruled in favor of pharmacy benefit managers, finding federal law preempts states from regulating their rates.

By Samantha Liss • Jan. 13, 2020

The government recovered $3B in fraud last year. Nearly 90% was from healthcare

It marks the 10th consecutive year the DOJ has recouped more than $2 billion from False Claims Act settlements and judgments for HHS.

By Rebecca Pifer Parduhn • Jan. 10, 2020

CVS, Mayo, Tenet among healthcare companies to watch at #JPM20

As many as 9,000 attendees across 450 public and private companies are expected to make an appearance in San Francisco at one of the most influential conferences of the year.

By Samantha Liss , Shannon Muchmore , Rebecca Pifer Parduhn • Jan. 10, 2020

Individual market appears stable despite lack of mandate penalty

Claims costs in the first nine months of 2019 grew and average hospital time dipped, indicating the market didn't have disproportionately sicker patients, according to the Kaiser Family Foundation.

By Shannon Muchmore • Jan. 8, 2020

Molina expands Illinois footprint with $50M acquisition

The buy of NextLevel Health Partners, if approved, would give Molina more members in Cook County.

By Samantha Liss • Jan. 8, 2020