Becker's Payer Issues | Payer News

Florida’s insurance commissioner has fined 13 pharmacy benefit managers a combined $12.66 million for violating state law, including insurer-owned PBM units. The penalties stem from market conduct examinations under Florida’s Prescription Drug Reform Act, which took effect in 2023. Regulators…

As ACA open enrollment gets underway, Oregon’s Division of Financial Regulation is warning consumers about health plans that label enrollees “limited partners” or “employees” to avoid state consumer-protection rules, as well as “sharing” plans that are not insurance. In a…

Elevance’s Carelon Behavioral Health will pay $2.35 million in penalties, fees and costs and up to $8 million in restitution under two settlements with New York Attorney General Letitia James’ office. The settlements, announced Nov. 10, resolve investigations into mental…

Individual coverage health reimbursement arrangements, recently rebranded to CHOICE, could boost individual ACA enrollment by up to 7.6% in some states while having little effect in others, according to an October analysis from actuarial consulting firm Wakely. The benefits model…

Philadelphia-based Jefferson Health is facing Dec. 31 contracting deadlines with Independence Blue Cross and Highmark — and Pennsylvania officials may get involved. Neither Jefferson nor IBX confirmed to Becker’s which specific product lines are affected by the contract negotiations, but…

CMS has issued more than two dozen fines against Medicare Advantage, Part D and special needs plans since January 2025, largely because of inadequate benefits administration or claims processing errors that caused enrollees to overpay for medical services and prescription…

Fitch Ratings believes CVS Health’s planned separation will be credit neutral for Aetna Life Insurance Co., the credit rating agency reported Nov. 9. One company, which will go by CVS Health in the interim, will encompass Aetna, pharmacy benefit manager…

Minnetonka, Minn.-based UnitedHealth Group made an unsolicited offer of $28 per share to acquire Brentwood, Tenn.-based Surgery Partners, Bloomberg reported Nov. 9, citing a person familiar with the situation. Surgery Partners rejected the offer over concerns about the deal’s complexity…