Medica reported an operating loss of $216 million on $6.3 billion of revenue for 2024. The company cited “historic levels of healthcare services utilization,” across all products and geographies. The operating loss includes $40 million for the company’s premium deficiency…
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Centene’s Medicare Part D enrollment is nearing 8 million members. According to CMS enrollment data from March 2025, Centene leads the nation in Medicare Part D membership with 7.92 million enrollees. The company has gained nearly 1 million members since…
Hawaii lawmakers have introduced legislation that seeks to address growing provider concerns around the prior authorization process. The bill would require insurers to report data related to prior authorization to the state and would introduce specific timelines for the approval…
Aledade and Humana are expanding their ongoing partnership to provide care under a value-based arrangement to Medicare Advantage members at Federally Qualified Health Centers and rural health clinics across 26 states. “This expanded agreement is an important development as it…
An Ohio jury awarded Medical Mutual of Ohio over $50 million in damages on March 12 after the payer prevailed in its lawsuit against FrontPath Health Coalition and HealthScope Benefits, a subsidiary of UnitedHealthcare. FrontPath offers employee benefits solutions, and…
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Ten providers recently posted job listings seeking leaders in payer contracting and relations.
The share of local Medicare Advantage plans has shrunk since 2012, while national insurers have increased their market share, a study published in the December issue of Health Affairs found.
Medicare spends more on beneficiaries who switch from Medicare Advantage to traditional Medicare compared to those who remained enrolled in traditional Medicare, a report from KFF found.
The USP Drug Classification PLUS is an offering from USP that provides online, interactive access to the USP Drug Classification (an independent drug classification of FDA-approved drugs, organized by categories and classes) with:
In an industry often criticized for its opacity, healthcare is undergoing a significant shift thanks to the CMS’s 2020 Transparency in Coverage ruling, which requires insurers and Payers to disclose the rates they negotiate with healthcare providers via detailed breakdowns…