GLP-1s are accelerating spending growth on traditional drugs, Evernorth research finds

Spending growth for simple medications used to treat common health problems is outstripping spending growth for pricey medications used to treat complex and chronic conditions, according to a new report from a Cigna subsidiary.

By Rebecca Pifer • Updated March 25, 2025

Optum Rx is reforming how it pays pharmacies

The massive PBM is pivoting to a cost-based reimbursement model, which it says will reduce variation in how pharmacies are paid. Pharmacy groups say that depends on the specifics of Optum Rx’s plan.

By Rebecca Pifer • March 21, 2025

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

Cigna closes $3.7B sale of Medicare business to HCSC

The deal, which removes Cigna from the volatile Medicare Advantage market, closed a little over a year after being announced.

By Rebecca Pifer • March 20, 2025

Medicaid work requirements could cut coverage for 5.2M

A new report found that millions could lose access to care, even though most Medicaid beneficiaries are working or should be eligible for exemptions from work requirements.

By Susanna Vogel • Updated March 24, 2025

Jefferson Health goes out of network for Cigna commercial members following contract spat

The Philadelphia-area system and major insurer have failed to reach a new agreement on payment rates, but are still continuing negotiations.

By Rebecca Pifer • March 19, 2025

Optum Rx says it will eliminate 10% of prior authorizations

The massive pharmacy benefit manager plans to stop requiring coverage reauthorizations for roughly 80 drugs used to treat migraines, multiple sclerosis, high cholesterol and more.

By Rebecca Pifer • March 19, 2025

Dr. Oz vows to scrutinize Medicare Advantage as CMS head

Mehmet Oz, who previously advocated for expanding the privatized Medicare program, said he would tackle upcoding among MA plans if confirmed.

By Emily Olsen • March 17, 2025

CMS nominee Dr. Oz says he supports Medicaid work requirements

Republicans are considering tying eligibility in the safety-net program to work, volunteer or education hours to meet spending targets.

By Emily Olsen • March 14, 2025

Nevada announces intent to award Medicaid contracts

The Silver State plans to award managed care contracts to newcomer CareSource and incumbents UnitedHealth, Elevance, Centene and Molina.

By Rebecca Pifer • March 14, 2025

CMMI cancels 4 payment models early

The CMS estimates terminating the models will save nearly $750 million. The agency will also no longer implement two demonstrations that aimed to improve prescription drug affordability and access.

By Emily Olsen • March 13, 2025

Cigna reshuffles C-suite amid rising costs

Cigna promoted Brian Evanko to chief operating officer and named a new chief financial officer in his place, while Eric Palmer will be leaving the company as an apparent victim of the restructuring.

By Rebecca Pifer • March 13, 2025

Medicaid expansion cuts could hit provider revenue, spike uncompensated care: report

If states end their expansion programs in response to funding cuts, spending on healthcare services would fall by nearly $80 billion and uncompensated care costs would rise by $19 billion in 2026, according to new research.

By Emily Olsen • March 12, 2025

Trump administration proposes ACA program integrity rule that would decimate enrollment

The rule is like “making people crawl through broken glass” for health insurance, one expert said.

By Rebecca Pifer • March 11, 2025

Republicans can’t meet budget target without Medicaid cuts: CBO

Excluding large health insurance programs, spending under the House Energy and Commerce Committee's purview falls far short of the budget blueprint’s $880 billion goal for cuts.

By Emily Olsen • March 10, 2025

Vertex’s new pain drug gets first coverage nod from major insurer

Optum Rx, the pharmacy benefit manager owned by UnitedHealth Group, placed Journavx on some of its commercial formularies in an interim decision while a formal review continues.

By Jacob Bell • March 6, 2025

EHR vendors turn to artificial intelligence to modernize health records

Software companies like Epic and Oracle say they’re weaving AI into clinicians’ workflows to meet client demand, keep up with competitors and improve the productivity of a swamped healthcare system.

By Rebecca Pifer • March 6, 2025

Older, self-employed enrollees more likely to lose ACA subsidies if enhanced tax credits lapse: KFF

Beneficiaries who earn more than four times the federal poverty level wouldn’t be eligible for any subsidies on marketplace plans if the enhanced premium tax credits expire at the end of the year.

By Emily Olsen • March 5, 2025

CVS sells Medicare Shared Savings business to Wellvana

The all-stock deal gives CVS a strategic minority investment in value-based care services firm Wellvana.

By Emily Olsen • March 5, 2025

Loss of enhanced ACA subsidies could batter state economies: report

Overall employment could fall by 286,000 jobs next year if the enhanced premium tax credits lapse, including 130,000 lost roles in the healthcare sector.

By Emily Olsen • March 4, 2025

Trump administration policies could create headwinds across healthcare: Fitch

The credit ratings agency is most concerned about Medicaid cuts and how government layoffs will affect device approvals.

By Susanna Vogel • March 3, 2025

[Podcast] The Payer Pod: Empowering Health Plans for Success in 2025

This podcast series explores the market forces impacting payers right now, how to reduce friction for providers, and ways to elevate member engagement.

Feb. 28, 2025

Federal Medicaid cuts could shift $44.3B in costs to expansion states

The 41 states that expanded Medicaid could be asked to spend 25% more to cover care costs if potential cuts are approved by Congress. Some states may cut the expansion program instead.

By Susanna Vogel • Feb. 27, 2025

Medicare Advantage growth slows as UnitedHealthcare nabs members, Humana sheds lives

The CMS released highly anticipated MA enrollment data on Tuesday that showed UnitedHealth further tightening its grip on the privatized Medicare market.

By Rebecca Pifer • Feb. 26, 2025

Centene expands board with former Prudential finance chief

The appointment of Kenneth Tanji brings the number of directors on Centene’s board to 12.

By Emily Olsen • Feb. 26, 2025

House Republicans pass budget blueprint that could spell Medicaid cuts

Although the budget resolution does not mention Medicaid specifically, lawmakers would be hard pressed to find enough cuts to meet an $880 billion target without touching federal healthcare programs.

By Sydney Halleman • Feb. 26, 2025