Prior authorization was a hot topic in 2025, from insurers pledging reforms to a Medicare pilot on the horizon. Here are five of the biggest stories on prior authorization from 2025: 1. Payers have been working toward meeting requirements for…
Author: Elizabeth Casolo
The Board of County Commissioners in Multnomah County, Ore., approved $2.4 million Dec. 11 to partially address a $4.6 million budget gap left when the state’s largest Medicaid provider, CareOregon, rolled back spending for behavioral healthcare, according to a Dec.…
Health insurance is the most-valued employee benefit among U.S. workers, according to a Dec. 4 report from Indeed’s Hiring Lab. The findings are based on Indeed’s 2025 Workforce Insights Survey, which polled 80,936 adults between May and June across eight…
Children continuously enrolled in Medicaid had lower emergency department use, according to a study published Dec. 22 in Pediatrics. The study was led by researchers from Ann Arbor-based University of Michigan, Atlanta-based Emory University, Minneapolis-based University of Minnesota and Columbia…
Stephanie Lagos — chief of staff for First Lady of New Jersey Tammy Murphy and deputy chief of staff to Democratic Gov. Phil Murphy — plans to join Horizon Blue Cross and Blue Shield of New Jersey’s board, according to…
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Montgomery, Ala.-based Jackson Hospital filed a lawsuit against Blue Cross and Blue Shield of Alabama over its reimbursement rates, according to a Dec. 18 complaint in the U.S. Bankruptcy Court for the Middle District of Alabama. Jackson Hospital is in…
The Interfaith Center on Corporate Responsibility, a coalition of faith- and values-based investors, filed a shareholder resolution requesting UnitedHealth Group publish a report “describing the healthcare consequences of its acquisitions over the past 10 years,” according to a Dec. 22…
Even amid a widespread regulatory crackdown on pharmacy benefit managers, some payers have been leaning into their own businesses in 2025. Here are six payer moves indicating growing PBM interest: 1. Independent Health’s PBM subsidiary, Pharmacy Benefit Dimensions, is one…
Payers still have a ways to go in meeting their goals ahead of CMS’ Advancing Interoperability and Improving Prior Authorization Final Rule, according to a survey from the Workgroup for Electronic Data Interchange. WEDI advises HHS on health IT. CMS’…
Aetna will settle with LGBTQ+ members over alleged discrimination with fertility treatments, according to mid-December court filings in the U.S. District Court for northern California. The court granted preliminary approval for the class-action settlement Dec. 17. Commercial Aetna members with…