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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.

More Middle-Class Californians Cancel Health Coverage After Losing Federal Aid

Facing higher premiums and the loss of federal subsidies, 374,000 people with health insurance from the state marketplace known as Covered California canceled their coverage in the first three months of the year, according to government statistics. The cancellations amount to 19% of those who had renewed their policies on the state marketplace during open ...

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Federal Rule Takes Aim at Health Care Bureaucracy, Reducing Dispute Fees, and Boosting Transparency

Major reforms were finalized today to strengthen the No Surprises Act by making the Federal Independent Dispute Resolution (IDR) process more efficient and transparent, while also saving money for millions of Americans. The final rule improves the process used to resolve out-of-network payment disputes between providers and payers—cutting administrative costs and improving how disputes are ...

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GoodRx Launches Subscription Program For Low-Cost Generic Medications, Telehealth Services

GoodRx announced Wednesday the launch of GoodRx Companion, a subscription program that offers access to virtual healthcare services and prescription medications at discounted prices. Through the $14.99 monthly GoodRx Companion subscription, users can access free and low-cost generic medications, online care visits and additional healthcare services. The company says the new subscription advances its strategy by adding ...

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Mark Cuban’s Cost Plus Drugs Often Beats Employer Plan Cost-Sharing Amounts

The Mark Cuban Cost Plus Drug Company pharmacy often charges prices for prescription drugs that are lower than employer plan cost-sharing requirements for those drugs, according to a new peer-reviewed research paper. Dr. John Lin, a researcher at the University of Texas MD Anderson Cancer Center in Houston, and his colleagues found that employer plans usually ...

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Amazon Taps Roy Schoenberg To Lead Healthcare Business As Neil Lindsay Plans To Step Down

Amazon has tapped digital health executive Roy Schoenberg, M.D., to lead its healthcare business as Neil Lindsay plans to step away from Amazon after 15 years. Lindsay, who led global marketing for Kindle and was a top executive in Amazon’s Prime business, shifted over to the online retail giant’s healthcare business in late 2021. At that time, ...

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Millions Expected to Lose Affordable Care Act Coverage As Costs Spike

The affordability crisis for many people who have health insurance under the Affordable Care Act came into sharper focus Tuesday, with a new analysis projecting that higher premiums will cause millions more people to lose insurance this year. Another sign of economic distress: Average deductiblesfor policyholders are now the highest ever, a result of people ...

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Hospital Stays, Specialty Drugs Drive High-Cost Claims

Secondary (comorbid) conditions, long inpatient hospitalizations and injectable drugs are the biggest drivers of expensive claims, according to the latest High-Cost Claims and Injectable Drug Trends report from Sun Life U.S. Other contributing factors include congenital anomalies, complicated surgeries and gene therapies, an analysis of more than 70,000 high-dollar claims medical claims from self-funding employers found. ...

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RFK Jr. Fires Leaders Of Group That Sets Guidelines For Preventive Health Screenings

The Trump administration has fired the two leaders of an influential health group that determines when insurance must provide free preventive care, like mammograms and colonoscopies, for millions of Americans. In letters dated May 11, Health Secretary Robert F. Kennedy Jr. notified the two doctors who chaired the U.S. Preventive Services Task Force that he was terminating ...

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CMS Proposes Rule Aimed At Limiting Medicaid State-Directed Payments

The Trump administration has proposed a “sweeping crackdown” on Medicaid payments that implements, and goes beyond, the reductions directed by last year’s sweeping One Big Beautiful Bill Act. Under a proposed rule, the Centers for Medicare & Medicaid Services takes aim at state-directed payments, aiming to bring Medicaid payments more in line with Medicare. The ...

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ACAP Warns Final ACA Rule Adds Further Uncertainty To A Market In Flux

The Trump administration recently finalized a major regulation governing the Affordable Care Act’s marketplaces, and community health plans are raising concerns about the impact the changes could have on consumers. Heather Foster, vice president for marketplace policy at the Association for Community Affiliated Plans (ACAP), told Fierce Healthcare in an interview that one of the biggest challenges ...

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