The Trump administration is withholding more than $1 billion in Medicaid funding to California and Minnesota over what it deems suspect claims. Tuesday’s funding suspension is the latest action by the Centers for Medicare and Medicaid Services to target Medicaid funding in the two states. More than $2.5 billion has been deferred from them due ...

The No Surprises Act’s arbitration process awarded close to $15 billion to providers in 2025, according to a Wall Street Journal analysis of federal data. Payouts through the independent dispute resolution process reached $14.85 billion in 2025, up from just $4.08 billion in 2024, the Journal reported. Arbitration firms collected about $1.3 billion in fees last year. “This law ...

A House member has an idea for making employer-sponsored health coverage cheaper and more flexible: Exempt the plans from the Affordable Care Act essential health benefits rules. The bill would, in effect, give small employers with fully insured group health plans a choice about whether to cover prescription drugs, maternity care or surgery, and it ...

Specialty drug trend remains high, although it decreased from 11.2% to 10.8% on a gross cost basis in Pharmacy Strategies Group’s 2026 State of Specialty Spend and Trend Report. Claim utilization is now the dominant driver of specialty drug trend as the percentage of members using specialty drugs rose to 5.5%. “For a decade, this ...

A federal appeals court has ruled that pharmaceutical manufacturers cannot unilaterally replace upfront discounts under the 340B Drug Pricing Program with after-the-fact rebates, affirming the federal government’s authority to approve how those price reductions are provided. The U.S. Court of Appeals for the District of Columbia Circuit upheld lower court judgments against Novartis, Bristol Myers Squibb, ...

U.S. hospitals are now treating fewer patients with health insurance purchased through an ACA exchange. Hospitals are also seeing more uninsured patients and patients with skimpy commercial coverage. The patients with high-deductible commercial coverage seem to be waiting until later in the year, when they have met their deductibles, to have elective surgical procedures. Executives ...