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...
by Jessica Casebolt | May 17, 2024 | Payers, Tea Leaves
Kansas has awarded new contracts in its more than $4 billion Medicaid managed care program to plans operated by incumbents UnitedHealth and Centene. CVS, however, was displaced by newcomer Healthy Blue, a plan majority owned by Elevance. Kansas’ Medicaid program,...
by Jessica Casebolt | Mar 11, 2024 | Payers, Tea Leaves
To combat growing criticism of prior authorization delays by payers, the Centers for Medicare & Medicaid Services (CMS) finalized a rule Wednesday that requires health plans to send prior authorization decisions within three days for urgent requests and seven days...
by Jessica Casebolt | Mar 11, 2024 | Payers, Tea Leaves
Wages have not been able to offset the rising costs of premiums for workers with employer-sponsored coverage over the last three decades, with Black and Hispanic employees hit particularly hard by this development, according to a study in JAMA Network Open. The...
by Jessica Casebolt | Mar 11, 2024 | Payers, Tea Leaves
The Blue Cross Blue Shield Association will lead an effort to improve maternity care in about 600 acute care and pediatric hospitals across the nation, including a push to address racial and ethnic disparities. Health equity in maternal care will be added to the list...
by Jessica Casebolt | Mar 11, 2024 | Payers, Tea Leaves
The Centers for Medicare & Medicaid Services (CMS) approved New York’s amended Medicaid section 1115 demonstration on Tuesday, spurring the agency to invest in behavioral health and health equity initiatives. The amendment, which expires March 31, 2027,...
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