Payer

Payers are implementing new programs to curb spending on prescription drugs, particularly specialty drugs. These medicines, prescribed to a small number of patients, accounted for half of prescription drugs costs in 2021, per HHS.

Danville, Pa.-based Geisinger Health Plan has been fined $125,000 for wrongly rejecting health insurance claims, PennLive reported Jan. 27. 

Cigna is suing former executive Amy Bricker and CVS, alleging her departure to the rival violated a noncompete agreement, according to a federal lawsuit filed Jan. 26. 

As many as 42 states could introduce bills this year to limit or change prior authorization, Miranda Motter, AHIP's vice president of state affairs, told Axios Jan. 27. 

Ten providers — including Cone Health and Orlando Health — recently posted job listings seeking leaders in payer contracting and relations.

Independence Blue Cross is launching a network to manage the cost and outcomes of gene-based therapies with Philadelphia-based Penn Medicine and Children's Hospital of Philadelphia. 

Angle Health, a health insurer that launched in 2021, has raised $58 million in series A funding. 

New enrollments in Florida, Texas, Georgia and North Carolina drove much of the growth in new ACA exchange plan sign-ups for 2023, The New York Times reported Jan. 25. 

California's reversal on its Medicaid managed care contracts has left industry insiders and consumer advocates questioning if the state will stick to its intention to reform Medi-Cal, California Healthline reported Jan. 26. 

Most people who are disenrolled from Medicaid are enrolled in some kind of other health coverage within 12 months, according to an analysis by the Kaiser Family Foundation published Jan. 25.