The Alabama Independent Pharmacy Alliance is pushing for transparency from pharmacy benefit managers, focusing on one in particular. The statement, published Dec. 23 in the Alabama Healthcare Examiner, specifically mentions the PBM Prime Therapeutics, which is jointly owned by Blue…
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Prior authorization was a hot topic in 2025, from insurers pledging reforms to a Medicare pilot on the horizon. Here are five of the biggest stories on prior authorization from 2025: 1. Payers have been working toward meeting requirements for…
The Board of County Commissioners in Multnomah County, Ore., approved $2.4 million Dec. 11 to partially address a $4.6 million budget gap left when the state’s largest Medicaid provider, CareOregon, rolled back spending for behavioral healthcare, according to a Dec.…
Children continuously enrolled in Medicaid had lower emergency department use, according to a study published Dec. 22 in Pediatrics. The study was led by researchers from Ann Arbor-based University of Michigan, Atlanta-based Emory University, Minneapolis-based University of Minnesota and Columbia…
CMS has proposed two new models aimed at curbing Medicare drug spending by linking payments to international benchmarks. The proposals — GUARD for Part D drugs and GLOBE for Part B — are the latest in the CMS Innovation Center’s…
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Individual coverage health reimbursement arrangements are at an inflection point — payers are catching on, but not to the point of industry mass-adoption, and some employers still have their doubts. Rather than providing a group health plan, employers can offer…
CMS has created an office focused on rural health transformation initiatives. The Office of Rural Health Transformation will oversee the $50 billion Rural Health Transformation Program, according to an announcement published in the Federal Register. The program aims to improve…
CMS is seeking input on whether its risk adjustment system disadvantages smaller Medicare Advantage plans, and one regional plan CEO says the answer is an emphatic yes. In its 2027 proposed MA rule, CMS said it recognizes the current risk…
The Louisiana Department of Health is extending UnitedHealthcare’s Medicaid contract through March 31, the insurer confirmed to Becker’s in a Dec. 18 statement. The state previously decided to cut the contract, which would have expired Dec. 31, thanks to an…
CMS is terminating its Medicare Advantage contract with American Health Plan of Texas after the insurer failed to meet minimum quality standards for three consecutive years. The agency issued a notice of termination Dec. 17 to the Franklin, Tenn.-based company,…