Pharmacy benefit managers could face new transparency requirements over fees they negotiate with drugmakers if a new rebate rule is approved.
In 2018, the Trump administration offered insurers and states extra tools to sidestep the Affordable Care Act. As costs and new competition rose, insurers sought courtships that further blurred the lines between payers and providers.
On-demand insurance lets customers buy some of their coverage only if and when they need it, similar to how TV viewers might rent a new release from Amazon instead of paying every month for a pricey cable package they rarely use.
Blue Shield of California has quietly scaled back the national Blue Card program that has allowed its members to receive a range of services out of state in an effort to reduce costs.
Nine groups representing health insurers, employers and consumers called for federal legislation to protect patients from surprise medical bills from out-of-network providers.
Enrollment in New Jersey's insurance exchange during open enrollment this year trails last year's sign-ups by 14%. That's despite state efforts to enact an individual mandate, implement a reinsurance program and prohibit short-term insurance plans.
The trend toward narrow-network plans has persisted since the inception of the Affordable Care Act exchanges in 2014. While it seems to have leveled out for 2019, it's unlikely that narrow networks will become less popular anytime soon.
Reinsurance programs have successfully stabilized individual insurance premiums and boosted enrollment in Alaska, Minnesota and Oregon, but the programs have been less effective at attracting more insurers to sell individual plans in those states.
Open enrollment is coming to a close for most employer-sponsored health plans. Though the percentage is still small, more and more companies are turning to direct contracting in benefit design.
Attorneys say whether a not-for-profit health system qualifies as a governmental entity that's exempt from federal rules on pension plans could expose gray legal area.
The early association health plans being formed under a Trump administration rule finalized in June claim to comply with Affordable Care Act rules, yet still deliver lower premiums than comparable ACA exchange plans.
Alabama's largest health insurer will stop covering OxyContin prescriptions as part of an effort to deter opioid abuse.