Becker's compiled some of the most-read payer stories of 2022. While half were about new federal policies, the others centered around mergers and disruptors within the industry.
HHS is maintaining the COVID-19 public health emergency until at least April
The agency last renewed the PHE Oct. 13 for an additional 90 days to Jan. 11, 2023 — it also told states it would provide a notice 60 days before if it did decide to end it, which would have been Nov. 11.
Anthem rebranded to Elevance Health
The company said it changed its name to a combination of the words elevate and advance to represent its commitment to "elevating the importance of whole health and advancing health beyond healthcare for consumers." In June, the company launched two new subsidiaries under the Elevance name: Carelon and Wellpoint. The 14 Blue Cross Blue Shield health plan names did not change.
Price transparency rules went into effect
Since July 1, payers have been required to disclose in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for all covered items and services, and negotiated rates and historical net prices for covered prescription drugs administered by providers.
Starting in 2023, payers must provide an internet-based price comparison tool that allows members to receive an estimate of their cost-sharing responsibility for a specific item or service from a specific provider or providers for 500 items and services. Price comparison tools must include all services by 2024.
Medicare Part B premiums and deductibles are decreasing in 2023
The standard monthly premium for Medicare Part B enrollees is $164.90 for 2023, a decrease of $5.20 from 2022, according to a September CMS fact sheet. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023 a decrease of $7 from 2022. The 2022 premium included a contingency margin to cover projected Part B spending increases for Alzheimer's drug Aduhelm.
Apple is reportedly launching a health insurance plan in 2024
The tech giant will reportedly enter the health insurance business in 2024 in partnership with a major payer, an Oct. 18 Forbes report said, quoting CCS Insight's chief analyst. Apple is already a flagship partner in John Hancock's Vitality program and UnitedHealthcare's commercial plans.
Centene quietly bought the St. Louis Ritz-Carlton
The St. Louis Post-Dispatch reported in June that Centene bought the city's Ritz-Carlton hotel for $98 million in 2018. A Centene spokesperson told the newspaper that the acquisition "met an immediate need" for hotel accommodation and it bought the hotel instead of building one.
CMS is cracking down on Medicare Advantage TV marketing
The agency will no longer allow MA or Part D prescription drug plans to advertise on television without agency approval first in a new policy effective Jan. 1. In December, CMS introduced a proposed rule to ban advertisements that don't mention a specific plan, along with those that use confusing words and imagery that misrepresent a plan.
UnitedHealth Group purchased Change Healthcare
A Washington, D.C., federal judge cleared the path for Optum to move forward with a $7.8 billion acquisition of Change Healthcare in September, which had been highly scrutinized by the federal government through an antitrust lawsuit.
CMS proposed a rule to improve the prior authorization process
The agency is looking to require electronic prior authorization processes that it estimates would save hospitals and physician practices more than $15 billion over a 10-year period. The proposed requirements would generally apply to Medicare Advantage organizations, state Medicaid/CHIP agencies, Medicaid/CHIP managed care plans, and qualified health plan insurers on the federally facilitated exchanges.
Payers are steering their members to Mark Cuban's pharmacy
Mark Cuban's online pharmacy, Cost Plus Drug Co. signed with its first payer partner, Capital Blue Cross, in October. The Harrisburg, Pa.-based insurer is the first in the nation to collaborate with the company and said its members will be able to use their insurance cards at Cost Plus starting in 2023. Cost Plus also said it's now collaborating with Vivio, a San Leandro, Calif.-based specialty drug management platform that markets itself as a PBM alternative, and partnered with PBM EmsanaRx in December.