Twelve independent Arkansas pharmacies have sued Express Scripts, alleging the PBM reimbursed them below the minimum required under Arkansas law tens of thousands of times. The lawsuit was filed Sept. 15 in St. Louis County Circuit Court. The pharmacies allege…
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The cost of healthcare remains one of the greatest challenges facing families, employers, and public programs. While discussions are focused on hospital prices, prescription drugs, and insurance premiums, one of the greatest opportunities to lower healthcare costs is expanding access…
HCA Healthcare CFO Mike Marks said payers have outpaced hospitals on AI-driven claims processing, adding another layer to the friction hospitals face on denials, underpayments and prior authorization. “I know there’s a lot of talk about AI in the hospital…
Forty states and Puerto Rico have signed agreements to join the Generous Model, a Medicaid drug payment initiative that ties prices for certain prescription drugs to what other developed nations pay, CMS announced Sept. 18. Four things to know: 1.…
Raleigh, N.C.-based WakeMed has reached a three-year contract for UnitedHealthcare’s employer-sponsored commercial plans, effective Oct. 15. WakeMed shared the update Sept. 17. The contract will grant members in-network access to hospitals, outpatient clinics and specialty physicians. An archived page from…
A New York state court has dismissed a lawsuit brought by two medical practices seeking more than $1.7 million from Elevance Health subsidiaries over unpaid No Surprises Act arbitration awards, ruling that the providers failed to make a viable claim…
Abbie Totten, Molina Healthcare’s California plan president, left her role Sept. 4. Ms. Totten had been approaching six years with the health plan, overseeing growth, forging strategic alliances and ensuring quality performance, according to her LinkedIn profile. Now, Ms. Totten…
Across the U.S., 7% of healthcare workers were uninsured in 2024, according to a KFF Health News report published Sept. 20 in The Washington Post. KFF‘s analysis was based on recent American Community Survey data. Fewer physicians opted out of…
Two hospitals set out to reduce maternal harm. Both have good clinicians, an analytics team and a quality committee. One joins a collaborative that hands it early benchmarking data, weekly working sessions with peers and a shared set of measures.…
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Elevance Health is laying off 216 employees in Louisiana as part of the wind-down of its Medicaid business in the state. The layoffs are set to take effect by the end of the year at the insurer’s Metairie office, according…