Blue Cross and Blue Shield of Alabama and the Medical Association of the State of Alabama agreed upon changes to prior authorization, according to a Nov. 4 news release. Over the past year, the insurer and the physician group collaborated…
Payer
A pair of U.S. senators sent a letter to CMS Administrator Mehmet Oz, MD, seeking answers for what they described as a “rushed launch” of the Medicare Advantage provider-directory tool. Sens. Jeff Merkley, D-Ore., and Ron Wyden, D-Ore., said in…
Fort Lauderdale, Fla.-based Broward Health and Hollywood, Fla.-based Memorial Healthcare System are partnering to offer Broward County residents a new health insurance option on the ACA Marketplace for 2026, The South Florida Sun Sentinel reported Nov. 1. The insurer, called…
Special needs plans are far from new, but they continue to hold promise as some insurers step back from Medicare Advantage. One KFF analysis attributed about half of MA enrollment growth since 2024 to SNPs, with 21% of 2025 MA…
From unveiling a rebate-free pharmacy model to debuting a controversial new downcoding policy, here are eight updates on Cigna that Becker’s has reported since Sept. 26: 1. The Cigna Group posted a $1.9 billion profit in the third quarter of…
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For all the progress made in shifting the U.S. healthcare system toward value-based care, one of the most powerful levers for improving outcomes and reducing costs remains underused: medications. Medications influence every dimension of health outcomes. They prevent disease progression,…
The Medicare Advantage (MA) market is entering a potentially transformative phase. Profit pressures, regulatory shifts, and an evolving reimbursement landscape are converging to prompt a strategic reset. A shift from growth-at-any-cost to profitability-first Like many publicly traded payors with significant…
The federal government has shut down for the first time since 2019 after lawmakers failed to reach a funding deal, with the fate of enhanced ACA subsidies, set to expire at year’s end, hanging in the balance. Premium tax credits…
The ACA marketplace’s open enrollment period kicks off on Nov. 1, but HealthCare.gov and states have price previews already available. The shopping window will remain open until Jan. 15, 2026, but those assessing their coverage face uncertainty. The fate of…