Eli Lilly plans to launch a direct-to-employer model for its GLP-1 medications in early 2026 in a move aimed at giving companies more flexibility in designing obesity management benefits for their employees. The model will include three components: flexible benefit…
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A federal court in Florida has approved a $3.4 million class action settlement resolving claims that Aetna improperly denied coverage for proton beam radiation therapy to treat cancer. The lawsuit was filed in 2020 by a Florida resident whose request…
Independent Health is joining MVP Health Care, another nonprofit insurer based in New York. Sharing assets is one reason for the member substitution agreement, but there is another opportunity for the organizations. Pharmacy Benefit Dimensions is a subsidiary of Independent…
Oregon health regulators have flagged three payers for “unreasonably high healthcare cost growth in 2023.” In an October report, the Oregon Health Authority said that Moda Health’s Medicare Advantage plans increased costs by 15.4%, PacificSource’s commercial plans grew 7.3%, and…
Insurers carry out chart reviews to verify alignment between medical records and information submitted by providers. While these reviews can help payers understand a beneficiary’s needs and increase payments to accommodate anticipated costs, they could also be used inappropriately. “Chart…
Gold Coast Health Plan appointed Suma Simcoe as COO, effective Oct. 15, according to an Oct. 30 news release. Ms. Simcoe joined GCHP from L.A. Care Health Plan and was previously at Molina Healthcare. She has a record of launching…
At the Fall 2025 Becker’s Payer Issues Roundtable, CareSource Senior Vice President Todd Carlson participated in a fireside chat on how the nonprofit payer is modernizing its technology infrastructure to deliver more personalized, efficient and scalable healthcare. In partnership with…
Over one-half of eligible Medicare beneficiaries are enrolled in Medicare Advantage plans this year, according to KFF. Given that enrollment and recent scrutiny, all eyes are on how the private alternative to traditional Medicare gets paid. A Nov. 20 KFF…
Vermont has the highest average ACA benchmark premium in 2026, while New Hampshire has the lowest, according to KFF. The U.S. average is $625. Premiums were analyzed using the second-lowest cost silver plan premium for a 40-year-old in each county…
Thirteen Democrats in the U.S. House of Representatives introduced eight bills aimed at reforming Medicare Advantage and solidifying traditional Medicare, according to a Nov. 19 news release from Rep. Mark Pocan, D-Wis. Each piece of legislation falls into one of…