More than 15.6 million people have enrolled in plans on federally run ACA exchanges so far, down from about 16 million at the same point last year, CMS Administrator Mehmet Oz, MD, said Dec. 23. Dr. Oz attributed the decline…
Payer
From releasing a companywide policy audit report to seeking the dismissal of a Medicare Advantage lawsuit filed by Ballad Health, here are 11 updates on UnitedHealth Group and its subsidiaries that Becker’s has reported since Dec. 4: 1. A federal…
A federal judge has granted UnitedHealthcare and PacificSource preliminary injunctions that block Idaho from taking action against the insurers over their Medicare Advantage broker compensation practices. The insurers sued Idaho Insurance Director Dean Cameron in November after the state issued…
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…
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…
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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…
Even amid a widespread regulatory crackdown on pharmacy benefit managers, some payers have been leaning into their own businesses in 2025. Here are six payer moves indicating growing PBM interest: 1. Independent Health’s PBM subsidiary, Pharmacy Benefit Dimensions, is one…
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…
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…