Payer

Pennsylvania Gov. Tom Wolf on Nov. 3 signed a bill aiming to streamline the prior authorization process. 

AHIP is pushing back on claims that Medicare Advantage markets are uncompetitive, calling a recent report from the American Medical Association "simply false and wrong." 

Friday Health Plans will not offer coverage on the ACA marketplaces in Texas and New Mexico for 2023, The Alamosa Valley Courier reported Nov. 4.

Medicare Advantage open enrollment is underway, and payers are expecting to see even more older adults choose the plans over traditional Medicare. 

CVS Health executives told investors Nov. 2 the company is expecting a $2 billion decline in 2024 revenues because of its lower Medicare Advantage star ratings in 2023 and the loss of its pharmacy benefits contract with Centene.

Millions of people are expected to lose Medicaid coverage when the federal public health emergency ends. This challenge presents an opportunity for states to address the issues of "Medicaid churn," researchers at New York City-based New York University and Boston-based…

Alignment Healthcare's overall losses are continuing to improve as the Medicare Advantage provider adds members and offerings. 

Centene has donated to political candidates in states where it is up for Medicaid contract selection or defending itself against overbilling accusations, sometimes through multiple subsidiaries, according to a Kaiser Health News report published Nov. 4. 

Senate Finance Committee Democrats are pushing for tighter regulation of Medicare Advantage marketing from CMS and Congress. 

More than 1 in 3 beneficiaries transition insurance 12 months before or after giving birth, a study published in JAMA Network Open Nov. 3 found.