UHC shooting fallout, Aetna revamps auth and Zing challenges CMS December 4, 2025 1. One year after CEO's killing, UnitedHealth navigates a financial reset Full story 2. Aetna merges prescriptions, procedures into single prior authorization Full story 3. 83% faster…
Payer Issues
J&J wins an employee benefits lawsuit and hospital-insurer network splits loom in ’26 December 3, 2025 1. CVS settles insulin dispensing case for $38M Full story 2. Judge dismisses lawsuit accusing J&J of mismanaging employee drug benefits Full story 3.…
Mangione returns to court and a contract break in NC leaves thousands without coverage December 2, 2025 1. Luigi Mangione returns to court for pretrial hearings in UnitedHealthcare CEO killing Full story 2. UNC Health goes out of network with…
UnitedHealth is leaving South America and another Blues plan is offering employee buyouts December 1, 2025 1. UnitedHealth to sell last South American business Full story 2. Arkansas BCBS offers employee buyouts Full story 3. EDs overcrowded, telemetry overused. A…
UnitedHealthcare says Idaho overstepped with MA regulations and Humana is appealing its star ratings November 28, 2025 1. UnitedHealthcare sues Idaho insurance director over Medicare Advantage commission crackdown Full story 2. What lessons health plan leaders will bring into 2026…
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CMS has published its ’27 MA proposed rule and payers are prepping for all ACA subsidy scenarios November 26, 2025 1. CMS pitches star ratings reform in 2027 Medicare Advantage proposed rule: 7 notes Full story 2. How payers are…
Trump delays an ACA subsidy proposal and UnitedHealth makes a big purchase in Nevada November 25, 2025 1. HHS appeals decision that struck down Medicare Advantage audit final rule Full story 2. Trump delays 2-year ACA subsidy extension proposal: Report Full story 3.…
Trump to pitch ACA subsidy extension and CMS expands site-neutral payments November 24, 2025 1. Trump to propose 2-year ACA subsidy extension with eligibility limits: Reports Full story 2. CMS ups hospital outpatient rates 2.6%, expands site-neutral payments in 2026:…
Democrats set their sights on Medicare Advantage reform and Lilly’s direct-to-employer GLP-1 model November 21, 2025 1. Democratic lawmakers target Medicare Advantage in wave of bills Full story 2. Oregon flags 3 payers over 'unreasonable' surge in healthcare costs Full story…
Cheaper GLP-1s could shift coverage policies and Centene is doubling down on D-SNP access November 20, 2025 1. Could cheaper GLP-1s signal a shift in payer policies? Full story 2. 'Passionate about making it better': Centene's Medicare CEO on expanding…