Oct 3, 2024 · UnitedHealthcare is adding deductibles to Part D prescriptions on certain formulary tiers as a result of plan design changes from the Inflation Reduction Act.

Jul 16, 2024 · For the second quarter of 2024, UnitedHealth’s earnings reached $98.9 billion, up almost $6 billion from the same quarter last year. The increase, company executives said, reflect growth at Optum and UnitedHealthcare. Second quarter adjusted earnings from operations were $8.7 billion and include business disruption from the Change Healthcare cyberattack.

Oct 1, 2024 · In 2025, Aetna, the health insurance company of CVS Health, has added several new programs to Medicare for 2025. Aetna will launch new Chronic Condition Special Needs Plans (C-SNPs) in Illinois (Chicago) and Pennsylvania (Philadelphia and Pittsburgh).

Apr 16, 2024 · Many of the new rules Congress is considering in the still-fluid pharmacy benefit management (PBM) legislation would add reporting requirements to meet transparency goals but wouldn’t fundamentally disrupt the industry’s business practices.

Dec 17, 2024 · Congress is working on an end-of-year package for funding the government through March 2025 that includes some changes for pharmacy benefit managers (PBMs) and group purchasing organizations.

Sep 16, 2024 · Prime, headquartered in Eagan, Minnesota, is one of six largest pharmacy benefit managers (PBMs) in the country, an industry that has come under increasing criticism and scrutiny for its business practices and vertical and horizontal consolidation trends.

Managed Healthcare Executive provides C-suite executives at health plans and provider organizations with news, analysis, insights, and strategies to pursue value-driven solutions.

Nov 29, 2024 · In its 50th anniversary this year, the Employee Retirement Income Security Act (ERISA), continues to allow employers to self-insure their health plans, highlights Paul Fronstin, director of Health Benefits Research at EBRI.

May 11, 2023 · The Covid-19 pandemic triggered a dramatic decline in patient volume that devastated revenues for provider organizations operating under the fee-for-service (FFS) reimbursement model. In response, more provider organizations have adopted alternative payment models (APM) built around financial incentives to efficiently deliver high-quality care.

Dec 19, 2022 · By almost any measure, the PBM business is one dominated by the major players. In 2021, CVS Caremark led the industry, controlling 34% of total adjusted claims, followed by Express Scripts (25%) and Optum Rx (21%).