Author: Scott Welch

A key cost-saving provision of the Inflation Reduction Act (IRA) goes into effect in the new year, limiting annual out-of-pocket spending on prescription drugs to $2,000 for Medicare beneficiaries. Starting on Jan. 1, 2025, an estimated 19 million Medicare beneficiaries will see their out-of-pocket Medicare Part D spending capped at $2,000 for the year. This ...

As a contract deadline approached on December 31, 2024, negotiations between Sansum Clinic/Sutter Health and Anthem Blue Cross reached a new agreement that could affect more than 129,000 patients. Sansum is the largest nonprofit medical group for outpatient care in the Santa Barbara area. The agreement allows patients to keep their in-network doctors and care ...

All of the commercial prescriptions dispensed at CVS pharmacies will be processed through its CostVantage reimbursement model beginning this year, the healthcare giant announced Monday. Under the model, prescriptions are priced based on the underlying cost with a delineated markup and dispensing fee to cover the services provided by CVS in the transaction. The company says this ...

Gov. Gavin Newsom issued an executive order on Friday attempting to limit access to ultra-processed foods, a directive he cast as a continuation of California’s “nation leading” nutrition and health standards. “The food we eat shouldn’t make us sick with disease or lead to lifelong consequences,” Newsom said in a statement. “California has been a ...

If you’re trying to keep on a healthy path in this first full week of the New Year, you’re likely adding more fruit to your diet. For most of us, go-to fruit selections are apples, bananas, grapes, maybe assorted berries — but there are many other fruits that you may not know about and are worth considering. ...

Governor Newsom signed over 1300 bills and vetoed almost 190 bills in 2024. Consistent with prior years, in 2024, California enacted multiple laws significantly impacting the health care industry. From artificial intelligence (AI) to providers to health plans, these new laws require proactive efforts to ensure on-going compliance. We highlight below the most important of ...

President Joe Biden has signed two bills that will ease some Affordable Care Act health coverage reporting requirements for employers. One is the Paperwork Burden Reduction Act, and the other is the Employer Reporting Improvement Act bill. The new laws affect the Form 1095-B and Form 1095-C notices that employers use to tell employees and the Internal Revenue Service about ...

Judges have been wrestling with state efforts to regulate PBMs, what health plans have to cover, and disputes over medical bills.

Stripped out of the final bill is a provision to prevent the 2.8% Medicare pay cut to physicians.

Even though there are still challenges facing the industry, healthcare executives are optimistic heading into 2025, with a new Deloitte survey showing 60% of C-suite leaders have a favorable view of the coming year, up from 52% a year ago. Most, 69%, expect greater revenues, while 71% anticipate improved profitability. After years of navigating their businesses through ...