CMS is rolling out the Medicare GLP-1 Bridge program — a demonstration designed to give eligible Medicare Part D beneficiaries access to certain GLP-1s at a fixed monthly cost — July 1. CMS officials, ...

Northwell Health and Fidelis Care are on track to end their contract July 15, a split the health system said will affect more than 240,000 patients across Medicaid, Medicare Advantage and Essential ...

Prior authorization reform is moving on multiple fronts in 2026 — through Congress, state capitals, federal courtrooms and the exam rooms where physicians spend an average of 13 hours per week on PA ...

UnitedHealthcare and Radnor, Pa.-based Main Line Health have come to “an agreement in principle,” the hospital system’s website said. Under the current contract, Main Line Health was set to go out of ...

Thirty-one House Democrats are seeking more information on CMS’ Wasteful and Inappropriate Service Reduction model. The lawmakers sent a letter to CMS Administrator Mehmet Oz, MD, June 22, requesting ...

Democratic senators introduced legislation June 25 that would cap out-of-pocket costs for traditional Medicare beneficiaries. The Medicare Cost Cap Act would install a $5,000 annual cap for Parts A ...

Kansas Attorney General Kris Kobach filed a lawsuit in state court June 24 against Aetna, alleging the insurer misused tens of millions of dollars while administering the state employee health plan.

Elevance is suing CMS again over MA star ratings + an actuary takes the lead at Cigna July 6, 2026 1. Elevance sues CMS over 2026 star ratings following Clover win Full story 2. 5 things to know about ...

Nine insurers have announced they will stop offering ACA marketplace plans, either nationally or in specific states, after the 2026 plan year. The withdrawals come amid declining enrollment nationwide ...

Elevance Health is suing CMS over its 2026 Medicare Advantage star ratings, arguing the agency gave competitor Clover Health a favorable recalculation after losing a court case to the insurer in May.

Federal prosecutors and auditors are targeting Medicaid behavioral health fraud on multiple fronts, with billions in alleged false claims under scrutiny nationally and two states alone facing audit ...

The ground is shifting beneath the healthcare industry, and payers know it. With federal Medicaid funding under scrutiny, enhanced ACA subsidies expired, value-based care models continuing to evolve, ...