Author: Mackenzie Bean

CMS has proposed including select Medicare Part B drugs in the third round of its drug price negotiation program, according to draft guidance released May 12.  The agency said the proposal is designed to enhance transparency, focus on high-expenditure drugs…

CMS will stop approving or extending Medicaid funding for certain state health programs that fund nontraditional or nonmedical services, the agency said April 10. Four things to know: 1. CMS notified states of the change April 10, which applies to…

Utah had the highest percentage of residents covered under employer-sponsored health plans last year, according to an analysis from KFF.

Only one health system — Gastonia, N.C.-based CaroMont Health — agreed to join the North Carolina State Health Plan during the second sign-up period, which ended Aug. 5, reports the Winston-Salem Journal.

Both commercial and federal health plans engage in various practices that complicate the emergency department revenue cycle, says Ed Gaines, JD, chief compliance officer at Zotec Partners.

Many payers are turning to creative strategies to improve members' medication use amid intense pressure to rein in costs and improve outcomes.

CMS launched the Part D Enhanced Medication Therapy Management model Jan. 1 in five Part D regions nationwide to test the use of innovative medication therapy management programs to improve care quality and decrease costs.

As healthcare providers continue to build alternative payment models and transition to value-based care, government and commercial payers are more often requiring providers to assume greater levels of risk.

America's Health Insurance Plans analyzed how $1 of a commercial health insurance premium is used by payers.

Blue Shield California proposed benefit changes for commercial plans next year that would force consumers to pay more to fill prescriptions at pharmacies outside of an established network, according to Kaiser Health News.