by Jessica Casebolt | Jun 11, 2024 | Payers, Tea Leaves
The Centers for Medicare and Medicaid Services (CMS) must recalculate Anthem Blue Cross and Blue Shield of Georgia’s Medicare Advantage star ratings, a federal court ruled Friday. Parent company Elevance Health sued over its scores in December, alleging CMS did not...
by Jessica Casebolt | Jun 10, 2024 | Payers, Tea Leaves
Humana and CVS, major players in the Medicare Advantage (MA) market, are anticipated to significantly reduce plan benefits and geographic coverage next year in pursuit of higher profits within the privately run Medicare program. This move could potentially lead to...
by Jessica Casebolt | May 30, 2024 | Payers, Tea Leaves
A recent survey by the Business Group on Health and Fidelity Investments underscores the continued importance of well-being programs for employers, with nearly all 160 surveyed firms considering them key to their overall strategy and planning to maintain current...
by Jessica Casebolt | May 24, 2024 | Payers, Tea Leaves
Express Scripts, one of the largest pharmacy benefit managers (PBM) in the country, has notched a major partnership with independent pharmacies amid contentious relations between the two industries. The Cigna-owned PBM unveiled a collaboration on Thursday with...
by Jessica Casebolt | May 23, 2024 | Payers, Tea Leaves
UnitedHealth-owned Optum Rx, one of the biggest pharmacy benefit managers in the U.S., is launching a new drug pricing model next year meant to make payers’ spending on pharmaceuticals more predictable. The model, called Clear Trend Guarantee, combines costs that used...
by Jessica Casebolt | May 21, 2024 | Payers, Tea Leaves
UnitedHealth said on Monday that its OptumRx unit would offer a new pricing model starting next year to help manage insurers’ costs for drugs. The new model, Optum Rx Clear Trend Guarantee, will provide value-based pricing of drugs per member, combining the cost...
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