Basing Medicaid drug prices on what other wealthy countries pay could save 47 states and the District of Columbia a combined $8.6 billion — about 35% of net spending on the drugs studied — according ...

Hawaii has the highest share of employers that offer health insurance to their employees, while Wyoming has the lowest, according to state-level data published by AHIP in July.

Nebraska employers lead the nation in self-funded healthcare benefits, with 73% of the state’s employer-sponsored insurance structured under ERISA rather than purchased from an insurer, according to ...

Two senators are demanding records from the three largest Medicare Advantage insurers over their use of AI and prior authorization to deny post-acute care to seniors. The senators are seeking records ...

Elevance Health plans to exit additional Medicaid markets over the next 12 to 18 months where it doesn’t see a viable path forward, executives said July 15 during the company’s second-quarter earnings ...

The Federal Trade Commission reached a settlement with CVS Caremark that requires the pharmacy benefit manager to change its business practices as part of the agency’s antitrust case alleging the PBM ...

Insurers estimate that they will pay more than $759 million in medical loss ratio rebates across commercial markets in 2026. KFF’s preliminary analysis is based on insurer-reported financial data from ...

“Payvider” — a portmanteau of “payer” and “provider” — commonly refers to healthcare organizations that have both care and insurance capabilities. Think: provider-sponsored health plans and ...

Support for expanding Medicare into a government-run health plan for everyone swings by nearly 20 percentage points depending on how the idea is described to voters, according to new polling that ...

Memorial Hermann Health System plans to shut down its commercial health insurance business. The wind-down affects the Houston-based system’s HMO, PPO, and self-funded products for employers. On its ...

John Prince, who spent nearly two decades in executive roles at Optum before moving into healthcare private equity, died June 28. He was 59. Mr. Prince died in Vero Beach, Fla., after a battle with ...

Nearly 5,000 independent pharmacies have filed a federal lawsuit against Prime Therapeutics, alleging the pharmacy benefit manager conspired with Cigna’s Express Scripts to suppress pharmacy ...