Becker's Payer Issues | Payer News

In the first six months of Medicare’s Wasteful and Inappropriate Service Reduction pilot, the use of targeted services fell in participating states relative to the rest of the country, according to a research letter published Oct. 26 in JAMA. The…

AmeriHealth Caritas is closing its specialty pharmacy in Orlando, Fla., leading to the elimination of 61 positions. The facility, PerformSpecialty, will shut down at the end of this year, according to regulatory documents filed with the state Oct. 29. Layoffs…

Nearly half of U.S. adults oppose AI playing any role in health insurance claim decisions, according to a Pew Research Center survey published Oct. 29. The survey of 3,488 adults, conducted in June, tested public openness to AI across eight…

Alignment Healthcare reported a net loss of $8.1 million in the third quarter amid higher-than-expected medical costs, according to its Oct. 29 earnings report. The company’s medical loss ratio was 89.5%, an increase of about 240 basis points year over…

A federal judge has partially denied a motion to dismiss a proposed class action accusing Anthem and Elevance Health of sharing member health data with vendors.  Anthem policyholders initially filed the complaint in an Indiana federal court in November 2025…

A federal judge in Massachusetts struck down a key part of CMS’ “medically frail” definition for Medicaid work requirement exemptions on Oct. 29. In June, 25 states and the District of Columbia sued the Trump administration over its interim final…

The Labor Department finalized a rule to promote transparency as pharmacy benefit managers work with large self-insured group health plans, shared during an Oct. 29 event.  The Wall Street Journal initially reported on the final rule one day ahead of…

Norfolk, Va.-based Sentara Health and Aetna have expanded their partnership to provide Medicare Advantage and Medicaid members with access to Sentara’s full network of hospitals, providers and care sites across Virginia. The agreement, which takes effect Jan. 1, 2027, will…