CVS Caremark and the Blue Cross Blue Shield Association overcharged the Federal Employees Health Benefits Program by a total of $615 million in pharmacy pricing between 2018 and 2021, according to a final audit report published by the Office of…
Payer
ACA enrollment reached 23.1 million in 2026, a 5% decrease from 2025, CMS reported March 27. While enrollment is down about 1.2 million consumers from the open enrollment period last year, 2026 enrollment is still 8% and 41% higher than…
A bipartisan group of four senators is advocating for stricter provisions under the proposed No Unreasonable Payments, Coding, or Diagnoses for the Elderly Act to address insurer upcoding, according to a March 30 letter sent to CMS Administrator Mehmet Oz,…
Healthcare payers are under growing pressure to improve performance across cost, quality, and outcomes. Rising medical and specialty drug spend, increasing utilization, and shifting market dynamics, such as changing Medicare Advantage reimbursement models, accelerating pharmacy costs, and evolving employer expectations,…
The ground is shifting beneath the healthcare industry, and payers know it. With federal Medicaid funding under scrutiny, enhanced ACA subsidies expired, value-based care models continuing to evolve, and state legislatures moving at their own pace on everything from AI…
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Seventeen Democratic Senators sent a March 26 letter to CMS Administrator Mehmet Oz, MD, criticizing a proposed ACA rule for 2027 that, they claim, “CMS’ own experts predict will kick 2 million Americans off the healthcare they have and accelerate the healthcare…
As states implement HR1 work and community engagement requirements, Medicaid, Med-Cal and Duals plans are confronting a familiar but intensified challenge: how to reach, educate, and support members who are historically the hardest to activate. The stakes are incredibly high.…
From naming a successor to its retiring CEO to defeating a class action over GLP-1 coverage exclusions, here are 10 updates on the Cigna Group and its subsidiaries that Becker’s has reported since Feb. 13: 1. Cigna was named to…
As value-based care continues to reshape the health insurance landscape, health plans face mounting pressure to evolve by continuing to become a true partner in care delivery. The shift demands more than operational adjustment — it requires a fundamental rethinking…
Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list. Listings were compiled from job-seeker sites. 1. Albany (N.Y.) Medical Center seeks an assistant director of system payer contracting. 2.…