Medi-Cal no longer covers GLP-1s for weight loss as of Jan. 1. Wegovy, Zepbound and Saxenda have been removed from the Medi-Cal Rx Contract Drugs List and are no longer eligible for coverage for ...

Enhanced ACA premium tax credits expired Dec. 31, leaving millions of marketplace enrollees facing higher premiums in 2026. Congressional efforts to extend the subsidies have stalled, with neither a ...

Delaware’s largest payer controls 93% of the state’s health insurance market, while Washington state’s largest insurer controls just 24%, according to KFF. The 2023 data was obtained from the “Health ...

Health insurers face a wave of regulatory and policy changes in 2026, from the expiration of enhanced ACA premium tax credits to tighter prior authorization rules and new state coverage mandates.

Health Care Service Corp.’s Blue Cross and Blue Shield of Texas filed a lawsuit against medical billing company Zotec Partners Dec. 18, alleging “abuse” of the No Surprises Act’s independent dispute ...

Mail-order pharmacies owned by UnitedHealth and Humana dispensed Medicare prescription refills earlier and more frequently than industry peers, according to an analysis of federal prescription data ...

Negotiated prices for 10 Medicare Part D drugs will go into effect Jan. 1, 2026, which could lead to $1.5 billion in out-of-pocket savings, according to a December AARP Public Policy Institute report.

State Medicaid agencies have made an estimated $289 million in improper capitation payments to managed care organizations on behalf of deceased enrollees since 2016, according to a series of audits ...

Payers still have a ways to go in meeting their goals ahead of CMS’ Advancing Interoperability and Improving Prior Authorization Final Rule, according to a survey from the Workgroup for Electronic ...

Bright Health owes CMS $380 million in risk adjustment payments from its shuttered insurance business, the company said Sept. 19. In regulatory filings, the company said its subsidiaries in Colorado, ...

Blue Cross and Blue Shield of Kansas has reached an agreement with Topeka-based University of Kansas Health System St. Francis Campus, also owned by Nashville, Tenn.-based Ardent Health Services, the ...

Almost 11 million people would become uninsured if Medicaid expansion states can’t fulfill spending obligations left by potential federal Medicaid cuts, according to a Feb. 24 analysis from the Urban ...