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Industry Updates

This broad category includes articles concerning health insurance costs, carrier and health plan news, changing benefits technology, and surveys by the Kaiser Family Foundation and others on employee benefits.

Supreme Court Takes Up PBM Case: Does ERISA Preempt States’ Efforts To Regulate Drug Prices?

The U.S. Supreme Court plans to look at states’ ability to regulate pharmacy benefit managers this term. Glen Mulready, Oklahoma’s insurance commissioner, is trying to overturn an appeals court ruling that found that the Employee Retirement Income Security Act of 1974 benefits rule uniformity provisions preempts state efforts to regulate PBMs when the PBMs are serving ...

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CMS Rolls Out Proposed Generic Drug List To Ease Cost-Sharing Burden

The Centers for Medicare & Medicaid Services (CMS) released a list of prescription drugs it hopes to include in its new Medicare $2 Drug List Model, the agency announced Wednesday. Designed to limit out-of-pocket costs, the plan caps a generic drug’s monthly price at $2. Drugs included in the list help tackle conditions like high ...

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Amazon Opening 20 New Pharmacies In U.S. Expansion Of Same Day Delivery

Amazon will more than double to 20 the number of cities where its customers can get same day delivery of their prescriptions by opening new pharmacies in these markets. The online retailer’s Amazon Pharmacy business said it will leverage its “vast logistics network and advanced automation technology to solve one of pharmacy’s biggest pain points: ...

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Health-Care Costs Hit A Post-Pandemic High. These Moves During Open Enrollment Can Help

About 165 million Americans get their health insurance through work, and yet most don’t spend much time considering what their employer is offering in the way of benefits and what it will cost. In fact, employees only spent about 45 minutes a year, on average, deciding which benefit options suit them best, a report from Aon found. Open enrollment ...

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What’s New and What To Watch For in the Upcoming ACA Open Enrollment Period

It’s that time of year again: In most states, the Affordable Care Act’s annual open enrollment season for health plans begins Nov. 1 and lasts through Jan. 15. Current enrollees who do not update their information or select an alternative will be automatically reenrolled in their current plan or, if that plan is no longer available, ...

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California Insurer Experiments With Drug Giveaway, Bypassing Secret Fees

A major California health insurer is set to offer one of the world’s top-selling drugs for free in a bid to show the medicine can reach Americans affordably without going through the middlemen that typically control its flow.

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Even Political Rivals Agree That Medical Debt Is an Urgent Issue

While hot-button health care issues such as abortion and the Affordable Care Act roil the presidential race, Democrats and Republicans in statehouses around the country have been quietly working together to tackle the nation’s medical debt crisis.

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CMS Proposes Risk Adjustment Changes, Broker Fraud Crackdown For 2026 Plan Year

A proposed rule from the Centers for Medicare & Medicaid Services (CMS) released Oct. 4 would protect beneficiaries from shady broker behavior and modify the federal risk adjustment program, among other changes. Under the Notice of Benefit and Payment Parameters proposed rule (PDF) for the 2026 plan year, insurance agents could be held responsible for marketplace violations. ...

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CMS Readies Changes For 2nd Round Of Drug Price Negotiation Program

The Centers for Medicare & Medicaid Services (CMS) rolled out guidance Oct. 2 as stakeholders prep for the second round of the drug price negotiation program. Made possible through the Inflation Reduction Act, the federal government has praised the program, saying it drastically lowers the cost of lifesaving drugs. The negotiation period for the first ...

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UnitedHealth Report Calls Out Policy Changes To Accelerate Shift To Value-Based Care

The healthcare industry is making the push toward greater adoption of value-based care, yet it’s not a secret that progress has been slow-moving. With that backdrop, UnitedHealth Group has released its latest “A Path Forward” report, which is a biennial look at progress in the shift to value. The paper includes dozens of policy recommendations ...

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