Payer
-
Win McNamee via Getty Images
GOP Medicaid cuts would cause thousands of preventable deaths: study
Medicaid provisions in Republicans’ reconciliation megabill would lead to between 8,000 and nearly 25,000 medically preventable deaths, according to new research in the Annals of Internal Medicine.
By Rebecca Pifer • June 17, 2025 -
Spencer Platt via Getty Images
Humana’s cautious defense of Medicare Advantage
At the insurer's investor day, Humana struck a middle ground in defending the importance of the privatized Medicare program — which accounts for the bulk of its revenue — while allowing that there’s room for improvement.
By Rebecca Pifer • June 17, 2025 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
Andrew Harnik via Getty Images
Senate Republicans propose deeper Medicaid cuts in reconciliation bill
Hospital groups slammed the Senate’s version of the GOP legislation. The upper chamber “made a bad bill worse,” said Chip Kahn, CEO of the Federation of American Hospitals.
By Emily Olsen • June 17, 2025 -
Anna Moneymaker / Staff via Getty Images
Hundreds of rural hospitals at risk if Medicaid cuts pass, Democrats say
The data released by a group of Democrat lawmakers found 338 rural hospitals were at risk of closure, conversion or service cutbacks if Republicans’ reconciliation bill becomes law.
By Emily Olsen • June 16, 2025 -
yavdat via Getty Images
Iowa passes law imposing tighter restrictions on PBMs
Last week, Iowa Gov. Kim Reynolds signed a law seeking to control rising prescription drug costs and protect rural pharmacies by targeting some of the drug middlemens’ most controversial practices.
By Susanna Vogel • June 16, 2025 -
Stock photo via Getty Images
Employers eye rising costs as they assess benefit offerings: WTW
In light of financial concerns, few employers plan to expand benefit offerings this year, WTW said.
By Susanna Vogel • June 12, 2025 -
Julia Rendleman via Getty Images
Cigna launches new generative AI assistant for members
The health insurer is trying to improve the customer experience by connecting them with an AI bot, but analyses show generative AI can make mistakes.
By Rebecca Pifer • June 12, 2025 -
JHVEPhoto via Getty Images
HHS watchdog accuses CVS Medicare Advantage plan of upcoding
The vast majority of diagnoses codes that CVS subsidiary Coventry submitted to the CMS between 2018 and 2019 weren’t supported by patient documentation, the HHS Office of the Inspector General found.
By Rebecca Pifer • June 11, 2025 -
Kevin Dietsch via Getty Images
More than half of adults worry Medicaid cuts could hurt healthcare access: KFF
Concerns about the policies are split along party lines. Still, more than 30% of Republicans said they were concerned the cuts could negatively impact their ability to get and pay for healthcare.
By Emily Olsen • June 10, 2025 -
DustyPixel via Getty Images
PBM lobby sues Arkansas over law requiring drug middlemen to sell pharmacies
The Pharmaceutical Care Management Association is following in the footsteps of two of its largest members — Cigna’s Express Scripts and CVS’ Caremark — that have also sued Arkansas over its controversial law.
By Rebecca Pifer • June 10, 2025 -
Joe Raedle via Getty Images
Public health scholars ask HHS to reject Georgia Medicaid work requirement extension
The American Public Health Association and dozens of other experts had harsh words for Georgia’s request to continue its controversial “Pathways to Coverage,” saying it enrolls fewer beneficiaries at a higher cost.
By Rebecca Pifer • June 6, 2025 -
Joe Raedle via Getty Images
Nearly 11M would become uninsured under GOP reconciliation bill: CBO
The latest analysis from the nonpartisan budget scorekeeper found 7.8 million would lose coverage due to Medicaid cuts.
By Emily Olsen • June 5, 2025 -
Anna Moneymaker via Getty Images
State exchange directors urge Senate to reconsider GOP megabill, citing harm to ACA enrollees
Seventeen states sent the letter to Senate leadership outlining how Republicans’ reconciliation legislation will kick millions off coverage, sicken risk pools and trample on state autonomy.
By Rebecca Pifer • June 5, 2025 -
erdikocak via Getty Images
Appeals court to rehear No Surprises case in bright spot for providers
The 5th Circuit could potentially cancel out a rare win it handed the federal government late last year in litigation over the No Surprises Act.
By Rebecca Pifer • June 4, 2025 -
Courtesy of Amazon
Amazon Pharmacy’s PillPack expands to Medicare patients
Amazon also announced a new feature allowing customers to invite caregivers to manage medications on their behalf as the e-commerce giant builds out its Amazon Pharmacy offerings.
By Rebecca Pifer • June 4, 2025 -
Alex Wong / Staff via Getty Images
HHS staffers sue over ‘hopelessly error-ridden’ layoffs
Most of the 10,000 HHS employees let go this spring could qualify for the class, according to lawyers. It’s the latest in a string of litigation against the Trump administration for drastically downsizing the federal workforce.
By Rebecca Pifer • June 4, 2025 -
Samantha Liss/Healthcare Dive
Centene sued over alleged ghost network following member’s death
Ravi Coutinho tried to access mental healthcare he thought was covered by his Centene plan to no avail. The 36-year-old was later found dead, and his mother — who is bringing the suit — believes Centene is to blame.
By Rebecca Pifer • June 3, 2025 -
Anna Moneymaker / Staff via Getty Images
HHS releases more detailed 2026 budget disclosing scope of cuts
On Friday, the HHS fleshed out a preliminary budget released in the spring and gave new details about which of its programs would be terminated if the Trump administration gets its way.
By Rebecca Pifer • June 2, 2025 -
Scott Olson via Getty Images
CVS, Cigna sue Arkansas to overturn new PBM law
The massive pharmacy middlemen contend that Arkansas’ law, which requires PBMs to divest pharmacies they own in the state, flies in the face of the Constitution and would worsen healthcare access.
By Rebecca Pifer • May 30, 2025 -
Permission granted by Elevance Health
Elevance sues Georgia providers for allegedly gaming No Surprises arbitration
Hospitalist Medicine Physicians, Sound Physicians Emergency Medicine and billing provider HaloMd allegedly filed thousands of ineligible disputes into the arbitration process, costing the insurer millions of dollars.
By Rebecca Pifer • May 29, 2025 -
CR via Getty Images
GLP-1 prescriptions for weight loss are shooting up, despite obstacles
The percentage of overweight or obese adults prescribed GLP-1s jumped by almost 587% between 2019 and 2024, according to a new Fair Health report.
By Rebecca Pifer • May 28, 2025 -
Alex Wong via Getty Images
Trump administration threatens states over Medicaid coverage for undocumented immigrants
The CMS told states it plans to go over their Medicaid spending with a fine-toothed comb to ensure federal dollars aren’t covering immigrants in the country illegally.
By Rebecca Pifer • May 28, 2025 -
Leigh Vogel via Getty Images
Medicaid cuts could threaten healthcare access for young adults: report
Young adults could struggle to navigate government bureaucracy and face other challenges managing work requirements or increased eligibility checks in the safety-net insurance program, the Urban Institute found.
By Emily Olsen • May 27, 2025 -
erdikocak via Getty Images
Trump administration updates price transparency guidance for hospitals and payers
Federal agencies are seeking public feedback on how to improve price transparency around prescription drugs and boost hospital compliance and enforcement.
By Susanna Vogel • May 27, 2025 -
Julia Rendleman via Getty Images
Evernorth reaches deals with Novo Nordisk, Eli Lilly to cap GLP-1 copays
The agreements cap patients’ monthly out-of-pocket costs for Zepbound and Wegovy at $200 and more deeply discount the drugs for Evernorth’s employer and health plan clients.
By Rebecca Pifer • May 22, 2025
