Payer

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 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. 

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.…

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. 

California's managed healthcare department fined Blue Shield of California $200,000 for mishandling provider claims. 

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 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.

Almost three-quarters of the nation's local Medicare Advantage markets are highly concentrated, according to the American Medical Association. 

Elevance Health's managed Medicaid plans in 21 states have been recognized by the NCQA for their advanced health equity efforts.

Almost half of the nation's local commercial insurance markets are majority controlled by one payer, according to the American Medical Association.