The retail pharmacy giant has also agreed to annually review its practices to ensure the state’s Medicaid program is getting the lowest possible prices for prescription drugs.| Healthcare Dive - Latest News
The investment in Shields Health Solutions gives Evernorth greater reach into specialty pharmacy services for providers, which Cigna’s COO has called an “important addressable market expansion opportunity.”| Healthcare Dive - Latest News
A federal register notice confirmed dates for the anticipated advisory meeting, which will follow an FDA decision to narrow COVID boosters' approval and comes as CDC leadership is in turmoil.| Healthcare Dive - Latest News
Only 13% of health system leaders agreed that their organization had a clear strategy for integrating AI, according to a survey from consultancy Sage Growth Partners.| Healthcare Dive - Latest News
The findings build on other research suggesting that MA insurers restrict care more than they should, especially post-acute services.| Healthcare Dive - Latest News
Federal lawmakers have proposed dozens of bills targeting core healthcare issues, including 340B, Medicaid, AI and site-neutral payments.| Healthcare Dive - Latest News
The deal’s closure also comes with a raft of leadership changes. Mike Motz, the former CEO of Staples U.S. Retail, has been appointed as Walgreens CEO effective immediately.| Healthcare Dive - Latest News
In a new report from Medscape, physicians say a lack of qualified applicants is hampering efforts to fill open positions. Many worry the situation could get worse over the next decade.| Healthcare Dive
More than half of respondents saw more procedure complications or reported poor outcomes due to care delays, while 28% said mortality rates rose.| Healthcare Dive
CMS will provide states monthly reports of beneficiaries whose citizenship or immigration status cannot be confirmed. States are expected to take “appropriate actions” including limiting coverage, the agency said.| Healthcare Dive
Lawmakers on both sides of the aisle are taking a harder look at coverage denials, fraud and waste in the popular program.| Healthcare Dive
The lawsuit alleges UnitedHealth used nH Predict to deny claims despite the algorithm’s determinations being overturned in more than 90% of appeals.| Healthcare Dive
Nearly three in four providers surveyed by Experian Health said the number of claims denied by payers shot up between 2022 and 2024.| Healthcare Dive
More than 80% of denied requests were overturned when appealed, but few beneficiaries formally questioned the decisions.| Healthcare Dive
The insurer is the latest to be hit with a suit over its use of algorithms to appraise claims.| Healthcare Dive
Physicians surveyed by the American Medical Association say prior authorization can cause care delays or force patients to abandon treatment. Denials could also increase as insurers adopt AI to review claims.| Healthcare Dive
Major insurers have agreed to six commitments that should make accessing care easier for patients while removing administrative burden on providers. But, the pledges’ voluntary nature makes compliance an open question.| Healthcare Dive
Beginning next year, the CMS will launch an AI-powered prior authorization process for some services as it seeks to cut funding for what it deems medically unnecessary care.| Healthcare Dive
The CMS plans to trial prior authorization requirements in traditional Medicare. A group of Democrat representatives think that’s a bad idea based on the tool’s track record in Medicare Advantage.| Healthcare Dive
Less than two weeks after stepping down, Prasad will return to lead CBER “at the FDA’s request,” an HHS spokesperson said. It's the latest twist in an unusual run to lead the FDA office overseeing vaccines and gene therapy.| Healthcare Dive
The healthcare juggernaut’s results came in unusually below Wall Street’s expectations and caused its stock to plummet Thursday. The development bodes ill for the rest of the managed care sector, analysts said.| Healthcare Dive
Osterhaus Pharmacy in Iowa — which is also suing CVS Caremark — is taking issue with pharmacy benefit managers’ use of performance-based fees that it says are contributing to independent pharmacy closures.| Healthcare Dive
The bipartisan agreement will fund the government through March. It could also reshape the pharmacy supply chain by reforming how controversial drug middlemen do business.| Healthcare Dive
The PBM Act would make companies like CVS and UnitedHealth that own health insurers or PBMs sell pharmacy assets. That would help independent pharmacies, but may not help patients, according to one expert.| Healthcare Dive
Agency commissioners voted unanimously on Tuesday to publish the report, which makes similar allegations against the controversial drug middlemen as the agency’s first report released last summer — but relies on more data.| Healthcare Dive
The KFF’s projection is steeper than an older analysis that relied on less complete data. It’s the largest increase that ACA insurers have asked for in more than five years as payers brace for membership turmoil.| Healthcare Dive
The American Civil Liberties Union called the ruling “a major victory for public health.” Federal officials are exploring their legal options, including an appeal.| Healthcare Dive
The Government Accountability Office can file a lawsuit in an attempt to restore the grants. However, the agency has not opted to do so during the second Trump administration.| Healthcare Dive
The healthcare giant’s new estimate is roughly $1 billion higher than previous forecasts as the cyberattack on subsidiary Change Healthcare continues to hamper its profit outlook.| Healthcare Dive
Centene continued to deal with a mismatch between Medicaid rates and patient acuity in the second quarter, but still exceeded Wall Street’s expectations thanks to Affordable Care Act growth.| Healthcare Dive
Conservative planning and continued business growth helped Molina keep an ongoing mismatch between payment rates and member acuity from dinging its bottom line in the third quarter.| Healthcare Dive
The insurer shrank its plan footprint for 2025 in a bid to improve margins. Now, Humana is giving market watchers loose guidance into how that reduction could affect its enrollment along with second quarter results.| Healthcare Dive
CenterWell said it will lease space at Walmart Supercenter stores in four states.| Healthcare Dive
Financial challenges at rural hospitals — driven by reimbursement problems — are leading facilities to shutter labor and delivery wards, the report found.| Healthcare Dive
One challenge hospitals face is reimbursement from private payers, which doesn’t cover the higher costs of care in rural areas, according to a report by the Center for Healthcare Quality and Payment Reform.| Healthcare Dive
Dually classifying allows urban facilities to benefit from rural health programs, even as many rural facilities struggle financially and are at high risk of closure, researchers wrote.| Healthcare Dive
Top executives of CVS Caremark, Optum Rx and Express Scripts made a rare congressional appearance to defend pharmacy benefit managers’ drug pricing policies.| Healthcare Dive
Pharmacy benefit manager lobby PCMA and drugmaker lobby PhRMA pointed fingers over problems in the prescription supply chain during the House committee's second PBM hearing on Tuesday.| Healthcare Dive
Antitrust regulators are poised to file suit against CVS Caremark, Express Scripts and Optum Rx over how they negotiate discounts for drugs, including insulin, according to the report.| Healthcare Dive
The report is not positive for the drug middlemen, which immediately criticized it as one-sided.| Healthcare Dive
Pharmacy groups cheered the news, which reversed a vote earlier this year by FTC commissioners not to investigate PBMs' pricing and contractual practices.| Healthcare Dive
The major PBM said its lawsuit is necessary to protect against misinformation about the controversial drug middlemen, while the FTC promised to defend its research.| Healthcare Dive
The Cigna-owned pharmacy benefit manager colluded with rival Prime Therapeutics to overcharge pharmacies, according to a lawsuit filed last week.| Healthcare Dive
Pharmacy benefit managers have largely avoided the brunt of public blame for the deadly opioid crisis. Arkansas’ lawsuit brings the drug middlemen back to the forefront of the controversy.| Healthcare Dive
Major pharmacy benefit managers continue to double down on specialty as a reliable source of business amid a growing crop of pharmacy upstarts.| Healthcare Dive
The infusion services and drug therapy company will operate under CarelonRx, Elevance’s pharmacy benefit manager.| Healthcare Dive
Worries about higher-than-expected medical spending have reached Medicaid, as redeterminations spark turbulence in the program.| Healthcare Dive
The investment, which the foundation says is its largest in women’s health, will support research in maternal health, obstetric care and sexually transmitted infections, among other areas.| Healthcare Dive
A coalition of 16 states and Washington, D.C. argue the Trump administration is trying to ban youth gender-affirming care without going through Congress.| Healthcare Dive
The watchdog said the payer submitted documentation that inaccurately showed some of its Medicare Advantage members were sicker than they actually were.| Healthcare Dive
The payer said it plans to vigorously defend its practices as the lawsuit alleges it put profits ahead of compliance.| Healthcare Dive
The payer used a medical assessment program to find health conditions that could raise risk scores of plan members, offering incentives to physicians who gave the exam, according to the lawsuit.| Healthcare Dive
Lagging vaccination rates lead the company to expect the pandemic to be a "modest negative for 2021," CFO Shawn Guertin said. Previously, it expected COVID-19 to have little to no impact on full-year earnings.| Healthcare Dive
The insurer is the latest to face allegations of receiving Medicare Advantage overpayments tied to patients who were inaccurately identified as part of a high-risk group.| Healthcare Dive
More than 60 companies, including Amazon, Google, UnitedHealth and Epic, have pledged to participate in the initiative, which the CMS said would “deliver results” early next year.| Healthcare Dive
Few concrete details emerged from the branding bid, but Haven's website and a letter from CEO Atul Gawande set lofty guiding principles for the venture.| Healthcare Dive
Legislation passed earlier this year also expanded premium tax credits and helped drive down premiums. More than 90% of those who enrolled during the SEP saw their premiums reduced.| Healthcare Dive
For most payers, higher-than-expected coronavirus costs were offset by patients continuing to delay nonessential medical care.| Healthcare Dive
An ongoing SEC probe could pose a significant risk to the payer, which gets most of its revenue from government programs.| Healthcare Dive
At question is whether insurers will be able to shift Medicaid members who lose coverage to subsidized marketplace plans.| Healthcare Dive
Children are at highest risk in Texas, Florida and Georgia when states resume checking Medicaid eligibility after the public health emergency expires, Georgetown University researchers found.| Healthcare Dive
The three-year continuation of enhanced subsidies for Affordable Care Act plans should help millions afford coverage and create some revenue stability for payers and hospitals in a tricky operational environment.| Healthcare Dive
Policy experts are worried, however, that progress on coverage expansion will be threatened when a moratorium on Medicaid disenrollment ends.| Healthcare Dive
At the latest congressional inquiry into pharmacy benefit managers, lawmakers argued the middlemen profit at the expense of patients and taxpayers.| Healthcare Dive
“The road ahead for prescription drug and pharmacy looks quite daunting,” said the CEO of the Business Group on Health following a recent survey.| Healthcare Dive
BSCA has kicked CVS Caremark, the largest pharmacy benefit manager in the country, to the curb and is electing to carve out various pharmacy functions with companies like Amazon instead.| Healthcare Dive
Cigna’s health services division Evernorth is also taking a stake in the deal, and will become a minority owner in VillageMD.| Healthcare Dive
Executives said Thursday that COVID-19-related costs were also higher than anticipated for the quarter.| Healthcare Dive
One analyst asked whether not pursuing deals will pose a disadvantage in future years. CEO David Cordani said he is open to M&A but does not think acquisitions are a “silver bullet.”| Healthcare Dive
It would have been the first time a sitting U.S. president attended the annual HIMSS conference, now canceled over coronavirus concerns.| Healthcare Dive
Promoting interoperability without clear guardrails could lead to healthcare's version of Cambridge Analytica, Epic wrote in a public statement coinciding with ONC's annual health IT conference.| Healthcare Dive
Officials from LifePoint, Omada Health and an IT group told a Senate panel more time is needed to process the rules and for implementation.| Healthcare Dive
The new iteration brings normative status, meaning future changes will be backward compatible.| Healthcare Dive
"Cancellation is unavoidable in order to meet HIMSS' obligation to protect the health and safety of the global HIMSS community," conference organizers told vendors Thursday.| Healthcare Dive
The AHA is pushing back against a proposal that electronic event notification be required to take part in Medicare and Medicaid.| Healthcare Dive
Star ratings bonuses reached $12.8 billion, according to the KFF, as the Medicare program faces a growing spending crisis.| Healthcare Dive
The QBP is a significant source of revenue for MA insurers, but generally doesn’t translate to higher quality care for beneficiaries, according to the nonprofit’s new report.| Healthcare Dive
Just 21% of CVS’ MA members are currently in plans with a star rating of at least four, down from 87% at the end of 2021, the payer disclosed.| Healthcare Dive
The budget also proposes to extend Medicare solvency and give the federal government more power to negotiate prescription drug prices.| Healthcare Dive
More than 100 current and former CommonSpirit facilities in 13 states might have been affected by the ransomware attack on the health system last year.| Healthcare Dive
The ratings agency said healthcare’s vulnerable state makes it “target rich,” which could bring service disruptions and personal data disclosures.| Healthcare Dive
The health system failed to implement safeguards to secure patients’ health information and provided insufficient details about the stolen data, the suit alleges.| Healthcare Dive
Celeste Mellet, currently the finance chief at an infrastructure investment fund, will take on the insurer’s CFO role in early January.| Healthcare Dive
Friday’s district court ruling is the latest suggesting the CMS might have to recalculate every MA plan’s star rating score due to an administrative oversight.| Healthcare Dive
The payer joins several other insurers suing federal regulators over the 2025 quality ratings, which Elevance argues will cost it at least $375 million in bonus payments and rebates.| Healthcare Dive
Centene is emulating other insurers unhappy with how regulators handled quality ratings for 2025. The flurry of complaints is “symptomatic of what appear to be systemic issues” with CMS calculations, Centene said.| Healthcare Dive
A handful of plans owned by the nation's largest MA payer are the latest to ask the court to help raise their valuable quality scores.| Healthcare Dive
About 40% of MA plans with prescription drug coverage will earn four or more stars, a dip from 42% this year, according to data released by the CMS.| Healthcare Dive
More than 60 Medicare Advantage health plans from 40 insurers have received a higher star rating for 2024, according to a Healthcare Dive analysis.| Healthcare Dive
The Thursday ruling means that, effective immediately, health plans nationwide are no longer required to fully cover certain preventative medical services like cancer, HIV and diabetes screenings.| Healthcare Dive
Along with shrinking the HHS’ workforce further, the reorganization announced Thursday will cut the department from 28 divisions to 15 and close five regional offices.| Healthcare Dive
Many HHS department heads and employees were unaware of plans to fire some 10,000 employees until they were publicly announced Thursday, sources said.| Healthcare Dive
Allowing physicians to practice their workflows with simulated scenarios can build confidence in EHR use and speed up tasks.| Healthcare Dive
About a quarter of healthcare leaders plan to add new technologies at the point of care in 2017, according to a HIMSS Analytics survey revealed at HIMSS17.| Healthcare Dive
Doctors are spending around two hours on EHR and administrative tasks for every hour spent with patients, a study published in Annals of Internal Medicine shows.| Healthcare Dive
The senator said removing financial conflicts of interest would build confidence in Oz’s impartiality. The nominee's confirmation hearing is scheduled to be held on Friday.| Healthcare Dive
The Biden administration is attempting to push through a slew of reforms to the controversial MA program in its final months in power, though it will need the Trump administration’s buy-in to get them across the finish line.| Healthcare Dive
Some limits on how the assessments are used might be justified to ensure Medicare Advantage plans aren’t overpaid, researchers wrote.| Healthcare Dive
Lawmakers argued Mehmet Oz, who was nominated to oversee the CMS, has pushed to expand MA while owning stock in the largest MA plan provider, UnitedHealth.| Healthcare Dive
Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this year, the insurer disclosed last week. The downgrade could wipe out Humana’s profits in 2026.| Healthcare Dive
