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Payer Issues

Cigna's rebate-free pharmacy model | Hawaii Medical Service Association's 1st female president | BCBS Mass. targets provider 'overcoding' | Okla. AG slams managed care Medicaid | Elevance's 'bullish' AI investments

Cigna’s Evernorth axes rebates, HMSA taps president, and Elevance’s AI push October 27, 2025 1. Cigna's Evernorth unveils rebate-free pharmacy model Full story 2. Hawaii Medical Service Association appoints 1st female president Full story 3. 83% faster status determinations. How…

By: Nikhil Gaikwad

Anthem may hit hospitals with 10% out-of-network penalty | Optum taps new CFO | 6 Medicare prior auth pilot updates | CMS brings back furloughed workers | Mont. opens BCBS query in wake of data breach

Anthem’s new out-of-network penalty, Optum names CFO, and CMS brings back workers October 24, 2025 Want to talk business strategy with health plan peers who get it? Join Becker’s Payer Leadership Virtual Community — a private, off-the-record digital forum for…

By: Nikhil Gaikwad

Molina cuts earnings outlook again | Dr. Oz: Shutdown not hurting open enrollment | Optum launches AI-powered claims system | Hospitals rebuke ‘aggressive coding’ accusations | Family coverage costs hit $27K

Molina cuts outlook, Dr. Oz talks shutdown, and Optum launches AI claims tool October 23, 2025 Want to talk business strategy with health plan peers who get it? Join Becker’s Payer Leadership Virtual Community — a private, off-the-record digital forum…

By: Nikhil Gaikwad

Tenn. system accuses UnitedHealth of 'MA manipulation' | Aetna cuts 72 jobs | Elevance: Tough year ahead for Medicaid | CMS awards national provider directory contracts | Calif. hormone therapy coverage mandate vetoed

UnitedHealth faces MA manipulation claims, Aetna announces job cuts, and Elevance braces for Medicai October 22, 2025 Want to talk business strategy with health plan peers who get it? Join Becker’s Payer Leadership Virtual Community — a private, off-the-record digital…

By: Nikhil Gaikwad
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Cigna, CVS partner with TrumpRx | Providence, Humana set new bar for interoperability | Best MA plans in '26: US News | Wellmark sues Iowa insurance commissioner | Calif. shutters 'sham' health plan

Pharmacy and plan shakeups — from Cigna’s TrumpRx deal to California’s crackdown on fake coverage October 20, 2025 1. Best Medicare Advantage carriers for 2026: US News Full story 2. Cigna, CVS partner with TrumpRx to offer fertility drugs Full story…

By: Nikhil Gaikwad

More layoffs at Blue Shield of Calif. | CMS walks back Medicare payment pause | MA directory errors found amid open enrollment | Highmark's new digital chief bridges the payer-provider divide | NY payer CEO to retire

Layoffs, leadership changes and Medicare confusion — payers navigate open enrollment October 16, 2025 1. Blue Shield of California to conduct third round of layoffs Full story 2. CMS walks back Medicare payment pause Full story 3. Old workflows, new…

By: Nikhil Gaikwad

Medicare open enrollment begins | Judge rebuffs Humana's 2nd star ratings lawsuit | Minn. shutters unlicensed insurer | UnitedHealthcare, Ascension Wis. ink contract | Telehealth pay confusion amid shutdown

Medicare open enrollment, Humana’s stars lawsuit rebuffed, and telehealth pay issues October 15, 2025 1. Medicare open enrollment begins: 6 notes Full story 2. Judge rebuffs Humana's renewed star-ratings suit Full story 3. Watch our expert webinar Maximize Your ROI…

By: Nikhil Gaikwad

Centene inks $40M network directory settlement | GLP-1 coverage could raise premiums by 14% | Payers, providers diverge on rising No Surprises costs | Mich. extends insurer tax amid Medicaid cuts | CVS outlines future of pharmacy

Network directory settlement, GLP-1 effects, and ongoing payer-provider tensions October 14, 2025 1. California settles network directory lawsuit with Centene for over $40M Full story 2. Covering GLP-1s could raise premiums by 14%: Study Full story 3. 3 genAI use…

By: Nikhil Gaikwad
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