Payer
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Medicare drug price cuts could have limited early impact, but grow with time
Some industry watchers described the level of price discounts announced by Medicare as a "relief," though they warned of bigger future implications for drug research.
By Jonathan Gardner • Aug. 16, 2024 -
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Deep DiveMedicaid overtakes Medicare Advantage as health insurers’ bogeyman in Q2
Despite challenges in Medicaid and MA, major insurers still posted large earnings in the second quarter — many helped by health services divisions.
By Rebecca Pifer • Aug. 15, 2024 -
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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 -
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Medicare reveals results of drug price negotiations
The agency said the first round of pricing talks, which involved drugs like the blood thinners Eliquis and Xarelto, will result in $6 billion in savings for taxpayers.
By Ned Pagliarulo • Aug. 15, 2024 -
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Medicare Advantage prior authorization denials increased in 2022: KFF
More than 80% of denied requests were overturned when appealed, but few beneficiaries formally questioned the decisions.
By Emily Olsen • Aug. 14, 2024 -
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Elevance, Clayton Dubilier and Rice unveil primary care venture Mosaic Health
New information is emerging about the joint care delivery platform first teased earlier this spring, which is launching without Elevance’s assets.
By Rebecca Pifer • Aug. 14, 2024 -
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CMS finalizes notice on Medicare coverage for breakthrough devices
The CMS will consider five medical device candidates yearly for national coverage through the new pathway, called Transitional Coverage for Emerging Technologies.
By Elise Reuter • Aug. 8, 2024 -
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Aetna executive ousted as CVS’ Medicare Advantage woes drag into second quarter
On Wednesday, CVS slashed its earnings guidance for the third time this year, announced a plan to cut $2 billion in costs and fired the head of its insurance division Aetna, which continues to struggle with high medical utilization.
By Rebecca Pifer • Aug. 7, 2024 -
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Uninsured rate jumps to 8.2% amid Medicaid unwinding: CDC
Growth in the nation’s uninsured rate could become steeper if subsidies in the Affordable Care Act exchanges expire on schedule next year, according to health policy experts.
By Rebecca Pifer • Aug. 7, 2024 -
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Premiums for ACA plans to grow 7% next year: KFF
Insurers cited workforce shortages, hospital consolidation and growing demand for pricey GLP-1 drugs as reasons driving the premium increases for 2025.
By Rebecca Pifer • Aug. 7, 2024 -
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Surprise BillingAppeals court hands providers latest win in No Surprises litigation
The 5th Circuit Court’s decision vacates instructions that arbiters should first consider the qualifying payment amount in deciding payments over contested out-of-network bills. Providers argued that unfairly advantaged insurers.
By Rebecca Pifer • Aug. 6, 2024 -
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Cigna CEO promises ‘aggressive’ defense of pharmacy benefit managers
David Cordani’s comments to investors Thursday come as the payer blew past Wall Street’s expectations for the second quarter, helped by significant growth in its health services division — including PBM Express Scripts.
By Rebecca Pifer • Aug. 1, 2024 -
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Disadvantaged areas less likely to have high-quality Medicare Advantage plans, study finds
The research, which found socially vulnerable counties were more likely to have MA plans rated under 3.5 stars, is the latest highlighting the importance of location in healthcare access.
By Rebecca Pifer • July 31, 2024 -
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Humana expects to lose ‘few hundred thousand’ Medicare Advantage members next year
The insurer shrank its plan footprint for 2025 in a bid to improve margins. Now, Humana is giving market watchers loose guidance into how that reduction could affect its enrollment along with second quarter results.
By Rebecca Pifer • July 31, 2024 -
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HealthEquity data breach could affect 4.3M
The health benefits administrator said a vendor’s user accounts were compromised, and information like contact details, Social Security numbers and medical information could have been exposed.
By Emily Olsen • July 30, 2024 -
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Fewer than half of US adults under 50 can readily afford or access healthcare, analysis finds
The share of Americans who were either “cost insecure” or “cost desperate” when it comes to healthcare have both increased since 2022, a Gallup and West Health survey found.
By Ryan Golden • July 30, 2024 -
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Growth in ACA plans keeps Medicaid giant Centene from worst of redeterminations impact
Centene continued to deal with a mismatch between Medicaid rates and patient acuity in the second quarter, but still exceeded Wall Street’s expectations thanks to Affordable Care Act growth.
By Rebecca Pifer • July 26, 2024 -
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Molina’s Medicaid growth offsets worst of redeterminations pressures in Q2
The California-based insurer also outlined how it remains acquisitive, despite recently sharing plans to purchase ConnectiCare.
By Rebecca Pifer • July 25, 2024 -
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Molina to acquire ConnectiCare for $350M
The acquisition, expected to close in the first half of 2025, will bring the health insurer into Connecticut.
By Emily Olsen • July 24, 2024 -
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PBMs battle bipartisan scrutiny as lawmakers eye industry reform
Top executives of CVS Caremark, Optum Rx and Express Scripts made a rare congressional appearance to defend pharmacy benefit managers’ drug pricing policies.
By Susanna Vogel , Rebecca Pifer • July 24, 2024 -
Courtesy of Humana
Humana’s CenterWell to open 23 primary care clinics at Walmart stores
CenterWell said it will lease space at Walmart Supercenter stores in four states.
By Emily Olsen • July 24, 2024 -
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Healthcare costs could grow up to 8% next year: PwC
The growth is driven by inflationary pressures, prescription drug spending and rising utilization of behavioral healthcare, according to the consultancy.
By Emily Olsen • July 22, 2024 -
Florida awards additional Medicaid contracts to CVS, UnitedHealth, Molina
The three payers were cut out of the state’s first round of contracts divvied out in April.
By Emily Olsen • July 22, 2024 -
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CMS cracks down on ACA brokers to prevent plan switching
Agents and brokers connecting consumers with Affordable Care Act plans now have to jump new hurdles to change their coverage, following mounting complaints about unauthorized plan switching.
By Rebecca Pifer • July 22, 2024 -
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Humana invests in Medicare choice tool Healthpilot
The startup uses AI to recommend Medicare Advantage, Medicare supplement and prescription drug plans based on enrollees’ healthcare preferences and needs.
By Emily Olsen • July 18, 2024 -
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UnitedHealthcare, Neighborhood Health Plan win Rhode Island Medicaid contracts
The state’s managed care organizations handle health benefits for 90% of its Medicaid beneficiaries each year.
By Emily Olsen • July 18, 2024
