Author: Rylee Wilson

Medicare Advantage plans could face mounting pressures in 2024 as medical utilization increases, and payers should prepare for shifts in the market, analysts say. 

CMS is proposing new coverage guidelines for HIV prevention drugs in Medicare, requiring the program to cover the drugs without cost sharing for beneficiaries. 

Competition between Blue Cross Blue Shield companies is increasing after a 2022 antitrust settlement that struck down some agreements limiting competition between BCBS Association members, according to a July 13 report from Advisory Board. 

Medicare Advantage enrollment has grown rapidly in recent years, now enrolling over half of Medicare eligibles. But payers shouldn't expect the growth to last forever, analysts for McKinsey and Company say. 

What do people get wrong about payers? Financial incentives, prior authorization and the differences between types of payers are some of the biggest misconceptions, executives told Becker's. 

Health Care Service Corporation, which operates Blue Cross Blue Shield affiliates in Illinois, Texas, Oklahoma, Montana and New Mexico, is expanding AI technology to speed up prior authorization. 

Payers use claims data, member demographics and more to uncover new findings. 

Payers should start evolving their strategies to be digital first, and streamline administration to respond to headwinds in the Medicare Advantage market, analysts for McKinsey and Company said in a July 11 report. 

Five of the 10 drugs with the highest Medicare Part D spending are diabetes treatments, including Ozempic, according to an analysis from KFF. 

Johns Hopkins HealthCare, the insurance arm of Baltimore-based Johns Hopkins Medicine, is rebranding as Johns Hopkins Health Plans.