CVS Health reported progress on key affordability and access initiatives, including reduced prior authorization burdens and expanded biosimilar adoption. The company has about half as many medical services subject to prior authorization as its nearest competitor, according to a Jan.…
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UnitedHealth Group’s Optum Rx is monitoring three notable drug candidates that might be approved in the next few months, according to its winter 2026 report published Jan. 2. Two of the medications Optum Rx is tracking are also on GoodRx’s…
Maryland is losing its longstanding rate-setting power for Medicare fee-for-service under CMS’ “achieving healthcare efficiency through accountable design” payment model. Commercial insurers are going to bear the brunt, needing to tackle about half of the state’s necessary savings and covering…
Clover Health CEO Andrew Toy is feeling bullish about his company’s AI positioning. “We are absolutely, in my mind, the AI leader in Medicare Advantage,” he said Jan. 15 at the J.P. Morgan 2026 Healthcare Conference in San Francisco. Clover…
President Donald Trump released a healthcare policy framework Jan. 15 that raises many questions about its implementation and legislative viability. The president’s proposal calls on Congress to codify voluntary drug pricing agreements with pharmaceutical companies, provide direct payments to Americans…
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Health plans have rapidly embraced AI for multiple use cases and leaders are focused on creating measurable performance improvement and achieving front-line buy-in. To learn more about how health plans are leveraging AI to improve payment integrity and performance, Becker’s…
Hospital leaders are getting long-awaited clarity from Congress this week as lawmakers unveil a bipartisan healthcare deal tied to a broader government funding package. The 771-page proposal includes major wins for providers, including a multiyear delay of Medicaid DSH cuts,…
Founded in 2023, Texicare — a Texas Mutual affiliate — offers health coverage to small businesses throughout the state. Texicare President and CEO Meredith Duncan previously worked at Aetna, Bright Health and Kaiser Permanente. She spoke with Becker’s about the…
CMS estimated there were $28.83 billion in improper payments for Medicare fee for service in fiscal 2025. Compared to 2024 reporting, that value is down from $31.7 billion. “While CMS’ improper payment reporting programs are designed to protect the integrity…
Bloomington, Minn.-based HealthPartners launched its copay-only health plan, Simplica NextGen Copay, this year. The plan sets prices for in-network care without a deductible or coinsurance. Moe Suleiman, senior vice president of commercial business, and Maggie Helms, senior vice president, chief…