Payer

Several states have implemented prior authorization reforms this year, but a majority of payers said state regulations make programs worse, according to a Nov. 14 survey from AHIP. 

More than four in five Medicare Advantage enrollees receive some kind of over-the-counter benefits, according to an analysis from Kaiser Family Foundation. 

Payers say the largest barrier to implementing alternative payment models is providers' reluctance to take on risk, according to a survey from the Healthcare Payment Learning and Action Network. 

Lawton, Okla. has the least competitive Medicare Advantage market in the country, according to a study from the American Medical Association published Nov. 1. 

The Consolidated Appropriations Act (CAA) of 2021 is long overdue legislation aiming to improve prescription drug price transparency and shed light on the role of pharmacy benefit managers (PBMs). 

Seventy-four percent of Americans are worried about rising health insurance costs, according to a Nov. 14 survey from personal finance site ValuePenguin.

An Anthem Blue Cross member has gone viral on TikTok again after the payer reversed course on a $40,000 cancer treatment bill, the Wednesday Journal reported Nov. 21.

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

About 8,000 contracted providers will begin receiving notices Dec. 1 that UnitedHealthcare is moving them to a new fee schedule, according to the California Medical Association. 

From CVS Health and Centene to several BCBS affiliates, this is where eight payer venture arms have recently invested: