CMS is set to launch a pricing model in January that could reshape Medicaid drug costs by aligning them with rates seen in other high-income countries. Eight things to know: 1. The program allows participating drug manufacturers to offer Medicaid…
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North Carolina Insurance Commissioner Mike Causey, the North Carolina Chamber and Blue Cross NC shared the state’s new multiple employer welfare arrangement during a Nov. 4 news conference. The initiative, called Carolina HealthWorks, will be available to members of the…
The Idaho Department of Insurance has ordered UnitedHealthcare and PacificSource Health Plans to immediately cease and desist practices that the state says intentionally limited access to Medicare Advantage plans and cut broker commissions during the ongoing open enrollment period. The…
Today, nearly half of Americans struggle to afford basic healthcare, and patients wait an average of 38 days to see a doctor. At the same time, 80% of at-risk members remain unreachable. These barriers are unsustainable for members and health plans alike. While value-based care…
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…
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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…
Today’s durable medical equipment (DME) process can be fragmented, inefficient and unreliable, leading to delays, errors, and rising costs. At Optum, we’re rethinking what’s possible with a transformative, digital, end-to-end experience that enhances efficiency, transparency, and reliability. Read more to…