In 2026, insurers have been taking steps to hone their specialty pharmacy approaches. While partnerships and greater discipline are part of some payers’ overall pharmacy approaches, specialty pharmacy ...

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 ...

Sustainability has become less about cutting costs and more about redesigning how healthcare delivers value. Becker’s asked several health plan leaders how they’re thinking about long-term ...

Longevity Health has earned a 5-star Medicare Advantage rating for its New Jersey Institutional Special Needs Plan, giving the payer its third 5-star contract following CMS’s recalculation of 2026 ...

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.

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 ...

Nearly 97% of UnitedHealth’s in-home Medicare Advantage diagnoses were supported by a patient’s medical record in 2025, according to a review commissioned by the company. The findings are the latest ...

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 ...