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State health plans decry weight loss drug costs for employees
North Carolina, Connecticut and Delaware's employee health plans are all grappling with how to cover the high cost of weight loss drugs, with each implementing limitations around coverage of the expensive medications. -
CareFirst sues J&J over alleged anticompetitive biosimilar tactics
CareFirst BlueCross BlueShield has filed a proposed class-action lawsuit accusing Johnson & Johnson and Janssen Biotech subsidiary of unlawfully delaying the introduction of biosimilar competition for ustekinumab. -
South Dakota lawmakers reintroduce Medicaid work requirement proposal
A pair of South Dakota lawmakers are seeking to put a ballot issue in front of voters in 2024 on whether the state should consider work requirements for those enrolled in the expanded Medicaid program, the Argus Leader reported Dec. 15. -
Why direct contracting, 'payviders' will become more prominent
While the world of healthcare remains ever changing, Seattle, Wash.-based First Choice Health, a provider and hospital-owned healthcare company, is looking to expand its network footprint in 2024. -
Blue Shield of California fined for mishandling provider claims
California's managed healthcare department fined Blue Shield of California $200,000 for mishandling provider claims. -
Hospitals to CMS: Add prior authorization appeal rates to MA star ratings
The Federation of American Hospitals is asking CMS to include how often Medicare Advantage carriers uphold or overturn initially denied prior authorization requests into how the agency calculates star ratings for the program. -
Kraft Heinz drops claims data lawsuit against Aetna
Kraft Heinz has voluntarily dismissed a lawsuit against Aetna alleging the payer breached its fiduciary duties and used its role as third-party claims administrator for Kraft's employee health plan "to enrich itself" to the food manufacturer's detriment. -
The cities with the most competitive Medicare Advantage markets | 2023
Almost three-quarters of the nation's local Medicare Advantage markets are highly concentrated, according to the American Medical Association. -
21 Elevance Medicaid plans recognized for advanced health equity efforts
Elevance Health's managed Medicaid plans in 21 states have been recognized by the NCQA for their advanced health equity efforts. -
The cities with the most competitive commercial insurance markets | 2023
Almost half of the nation's local commercial insurance markets are majority controlled by one payer, according to the American Medical Association. -
2 ASCs seek COVID-19-era reimbursements from Arkansas BCBS
Two Little Rock, Ark.-based ASCs are seeking potentially millions of dollars in unpaid reimbursements from Arkansas Blue Cross and Blue Shield for procedures performed during the COVID-19 pandemic, Arkansas Business reported Dec. 11. -
45% of employer group market can be disrupted, Centene CEO says
Centene CEO Sarah London foresees major disruption opportunities ahead in the employer group insurance market by way of individual marketplace coverage. -
Humana used AI tool from UnitedHealth to deny Medicare Advantage claims, lawsuit alleges
Humana used an artificial intelligence tool owned by UnitedHealth Group to wrongfully deny Medicare Advantage members' medical claims, according to a class-action complaint filed Dec. 12. -
10 providers seeking payer contracting talent
Ten providers recently posted job listings seeking leaders in payer contracting and relations. -
UnitedHealth Group in the headlines: 12 updates
From its Optum arm adding nearly 20,000 physicians in 2023 to outlining its 2024 revenue expectations, here are 12 updates on UnitedHealth Group that Becker's has reported since Nov. 27: -
Centene projects $142.5M+ in 2024 revenue, announces $4B stock repurchase program
Centene expects 2024 revenues to be at least $142.5 billion -
Centene spent $307M to settle state overbilling allegations in 2023
A settlement agreement with South Carolina in late December brought the total amount that Centene paid in 2023 to resolve allegations it overbilled state Medicaid programs for pharmacy services to $307 million. -
Humana dissolves executive committee
Humana has disbanded its executive committee, according to a Dec. 7 regulatory filing from the company. -
Advocacy groups decry UnitedHealth's 'misleading' Medicare Advantage marketing
Groups advocating on behalf of older adults and people with disabilities are asking federal agencies for a "full-scale investigation" following what they say are misleading Medicare Advantage advertising practices by UnitedHealthcare. -
Medicaid in the headlines: 7 recent updates
North Carolina officially implemented Medicaid expansion, and CMS laid out plans to crack down on states violating federal laws around Medicaid redeterminations.
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