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Free Newsletters
“BenefitsLink continues to be the most valuable resource we have at the firm.”
-- An attorney subscriber
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Search the News Archive
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239 Matching News Items |
| 1. |
FierceHealthcare
Nov. 10, 2025
"UnitedHealthcare's new policy says remote patient monitoring (RPM) is only medically necessary in two instances: to treat chronic heart failure and hypertension during pregnancy. It explicitly says the use of RPM for Type 2 diabetes and hypertension -- two of the most popular uses of RPM -- will no longer be covered."
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| 2. |
FierceHealthcare
Oct. 27, 2025
"U.S. consumers across the political spectrum are largely in favor of new legal protections against medical debt, and the majority are laying blame at the feet of the insurance industry rather than other healthcare players like hospitals or drugmakers ... [A recent survey] found about 35% currently owed money or have debts due to medical and dental expenses. Eighty-four percent said they believed having health insurance should protect people from medical debt, and 74% said the country's current health insurance system is 'mostly failing' in protecting from medical debt."
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| 3. |
FierceHealthcare
Oct. 13, 2025
"[SB 41 requires] all PBMs in the state to be licensed by its Department of Insurance and prohibits multiple business practices that have drawn the ire of PBM critics, namely spread pricing arrangements and efforts to steer patients toward affiliated pharmacies. The legislation also mandates that PBMs pass all rebates through to the payer or patient and bars these companies from making exclusivity deals with drugmakers[.]"
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| 4. |
FierceHealthcare
Oct. 10, 2025
"Most employers offer coverage for mental health services, but where they fall short is in tracking whether those benefits are working, according to a new survey.... [T]here is a significant opportunity for employers to do more in tracking network adequacy ... 73% of those surveyed covered telehealth, and 62% covered counseling and therapy visits. But notably fewer offered coverage for ongoing chronic needs (33%) or for culturally competent care (26%)."
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| 5. |
FierceHealthcare
Oct. 1, 2025
"The White House announced Tuesday it was rolling out a direct-to-consumer website where individuals can buy prescription medications at discounted prices rather than through insurance.... It's unclear whether the website would be limited to Medicaid patients. The White House said ... that "virtually all drugs" will be available discounted on the site."
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| 6. |
FierceHealthcare
Sept. 25, 2025
"[T]he Pharmaceutical Care Management Association (PCMA), which represents PBMs ... is pitching business changes to [CMS] in a bid to avoid further regulation. Proposals include increased payments to rural and independent pharmacies, a larger focus on the use of lower-cost biologics and steps to ensure patients' costs aren't higher than cash-pay rates[.]"
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| 7. |
FierceHealthcare
Sept. 18, 2025
"AHIP said its plans will continue to cover all vaccines recommended by the ACIP as of Sept. 1, 2025, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026. Members of AHIP include major insurance companies Aetna, Centene, Cigna, Elevance Health and Humana as well as major Blues plans and other health insurance plans like Oscar Health."
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| 8. |
FierceHealthcare
Sept. 9, 2025
"31% of respondents had their primary PBM contract with a transparent organization rather than one of the traditional leading companies. That's up from 12% that had a primary contract with a PBM in 2024 ... The share of respondents contracting with the 'Big Three' -- CVS Caremark, Express Scripts and Optum Rx -- declined in tandem, with 61% saying they contract with one of these companies. By comparison, 72% were contracted with one of the Big Three in 2024."
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| 9. |
FierceHealthcare
Aug. 27, 2025
"[R]esearchers from Georgetown University estimate that between 2022 and 2024, the IDR system cost $5 billion to manage. The largest chunk of that is the additional payments from plans to providers, totaling $2.24 billion. That figure also accounts for $1.9 billion in internal costs for payers and providers as well as $656 million in IDR entity fees. Administrative fees were $228 million, according to the analysis."
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| 10. |
FierceHealthcare
Aug. 18, 2025
"Since 2022, health plans have been required to release machine-readable files disclosing negotiated rates of healthcare services with providers. Hospitals are also required to release the costs of shoppable services. Data analytics firm Trilliant Health ingested UnitedHealthcare and Aetna transparency files from February to April 2025 to create a new report. Now, those massive swaths of information are slowly becoming more actionable for employers[.]"
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