Payer Contracting

UPMC Health Plan is adding a preferred pharmacy network to its ACA plans, reducing the number of pharmacies available to members by 60 percent, The Pittsburgh Post-Gazette reported Jan. 5. 

Aetna and Munster, Ind.-based Community Healthcare System have agreed to a contract extension, avoiding a split that would have left Aetna commercial and Medicare Advantage members out of network. 

Aetna will manage health insurance for more than 740,000 North Carolina state employees, winning a contract BCBS North Carolina has held for over 40 years. 

As year-end deadlines approached, several payers and providers struck new deals to keep patients in-network. 

Although California is awarding more payer contracts to its Medi-Cal program, Molina Healthcare — who won big in the state's initial August 2022 award — is expecting its California Medicaid revenue will double. 

Regence BlueShield of Washington and Optum-owned Everett (Wash.) Clinic and Polyclinic have reached an agreement to keep 19,000 commercial members in-network. 

California is awarding more payers contracts to manage its Medicaid program, reversing course on contract awards that could have forced two million Medi-Cal members to switch insurance. 

Memphis, Tenn.-based Methodist Le Bonheur Healthcare is out of network with Blue Cross Blue Shield of Tennessee after the sides were unable to reach a new agreement by Dec. 31, the Memphis Commercial Appeal reported Jan. 2. 

Cigna and Toledo, Ohio-based ProMedica have finalized an agreement to keep the health system's patients in network with the payer, ABC affiliate WTVG reported Dec. 29. 

UnitedHealthcare is extending its contract with Syracuse, N.Y.-based Upstate University Hospital by two months as the sides look to avoid a coverage disruption for about 20,000 patients, syracuse.com reported Dec. 29.