Payer

The Biden administration issued proposed rules July 7 that aimed to crack down on "junk" short-term health insurance plans. 

Caps on Medicare prescription drug costs will save Part D enrollees a collective $7.4 billion in 2025, according to a report from HHS' Office of the Assistant Secretary for Planning and Evaluation. 

Over the last two years, Priority Health's maternity management program, "PriorityMOM," has achieved a 16 percent decrease in emergency room visits for pregnant members who may experience complications pre- or post-delivery. 

There are several demographic and socioeconomic differences between individuals who select traditional Medicare coverage versus Medicare Advantage plans before they turn 65 and who have commercial insurance, according to a new study from researchers at Harvard Medical School and software…

As the number of Americans with Alzheimer's disease or related dementias continues to grow, a survey of payer executives suggests the industry is moving too slow or not at all toward better managing cognitive decline among members.

The Medicare Advantage star rating system and its quality bonus payment program is failing to achieve its two main goals of helping beneficiaries select a plan and incentivizing payers to improve plan quality, according to a new report from the…

The most common reason health plans and employers do not pay for pricey weight loss drugs is because they consider these medications to be lifestyle drugs, according to a survey from Pharmaceutical Strategies Group. 

Georgia is implementing work requirements for Medicaid, and other states could follow. 

Molina Healthcare had the largest gains in Medicaid enrollment during the COVID-19 pandemic, according to a report from KFF published July 6. 

"Look-alike" dual eligible Medicare Advantage plans — which primarily enroll people eligible for Medicare and Medicaid but are not regulated as D-SNP plans — grew significantly from 2013 to 2020, a study published in the July issue of Health Affairs…