CVS Health's Aetna will stop offering plans on the Affordable Care Act (ACA) healthcare individual exchange in 2026 as the company projects major losses this year. Health plans preparing to submit Marketplace rate proposals are considering scenarios with and without cost savings reductions, but APTCs aren't included.
The announcement...National News
CVS Health may be looking to split its retail and insurance branches following pressure from investors to improve performance. The company is also facing a hefty bill from an audit by the U.S. Department of Health and Human Services Office of Inspector General (OIG) that found it owes millions in overpayments.
CVS's profit margins at...Arizona News
As of last Friday, April 5, 2024, most Dignity Health facilities and providers in Arizona are no longer considered part of Aetna’s network. Dignity Health Yavapai Regional Medical Center remains in-network but Yavapai Regional Medical Group is subject to termination.
Aetna and Dignity Health have been negotiating for several months...Arizona News
CVS Health, the largest drugstore chain in the country, will move to a simpler model for setting the prices of prescription drugs.
The new payment model, CostVantage, was announced on Tuesday. According to AZCentral, the chain's 9,000 pharmacies will have a reimbursement rate that defines the cost of the drug using a "transparent...Arizona Comings & Goings
On Tuesday, CVS Health announced that it had completed its acquisition of Oak Street Health, a primary care provider which boasts 170 medical centers in 21 states. The acquisition is the latest in a long line of efforts by retailers to break into healthcare.
CVS Health paid $10.6 billion in cash for the network, and intends to grow...
UnitedHealth Group (UHG) also reported its Q1 2023 earnings rose to $5.61 billion while competitor CVS Health named former Humana CFO Brian Kane the new EVP and president of Aetna effective September 1, 2023.
During UHG's most recent earnings call executives reported revenue growth at 15% YOY across all lines of business. The...
It's the time of year for insurers to file their fourth quarter (Q4) earnings reports for 2022. This week, Molina, Kaiser Permanente and Oscar Health posted financial metrics.
Oscar Health beat the odds in 2022 by improving its medical loss ratio from 88.9% in 2021 to 85.3%, Modern Healthcare reports. But the healthtech company still...National News
If insuretech startups promised one thing, it was that they had a bulletproof plan to game the insurance market, attract a ton of enrollees to their plans and produce hand-over-fist returns for their investors. After several quarters of substantial losses, investors are losing interest and companies like Oscar Health, Clover Health and...National News
Children between six months and five years old are now eligible for the COVID-19 vaccines offered by Pfizer and Moderna. In Arizona, that's nearly 400,000 additional eligibilities.
According to the Arizona Department of Health Services (ADHS), the vaccine was made available on Monday, June 20. To find locations where a child under 5...
As fallout continues from the leaked Supreme Court (SCOTUS) opinion on Dodd v. Jackson Women's Health, in which it appears that the court plans to overturn Roe v. Wade (1974), policymakers and industry stakeholders are lining up to support for reproductive healthcare.
The American Medical Association released a statement on the leaked...
As COVID-19 cases drastically subside following the surge related to the Omicron variant, Americans are beginning to relax restrictions and anxieties related to the pandemic. However, other countries around the world are now struggling to contain Omicron surges that arrived much later and experts are warning that complacency could invite...
With the rise of the Omicron variant continuing the COVID-19 pandemic into the foreseeable future and the Build Back Better Act stalled in Congress, the landscape of healthcare in 2022 is somewhat uncertain. Two analyses, one from the U.S. Office of Public Policy and the other from the J.P. Morgan 2022 Healthcare Conference, lend some...
Medicare Advantage and the hundreds of investors pumping venture capital into new MA startups rely on one thing: MA growth. For the past several years, MA has been on a quick trend upward, but as it currently only captures under 50% of the market, some are left wondering if the seemingly endless demand isn't just a giant investment...Arizona News
This week in insurance, mergers and acquisitions open new pathways to addressing social determinants of health (SDOH) and innovative medical options for plans and patients alike.
According to new research released by Verint, "the Customer Engagement Company," the top 25 health insurance companies were in tight competition throughout...News
This week a large amount of analysis on how the Affordable Care Act, insurance rates and private insurance faired during the ongoing COVID-19 pandemic. Also, due to increased enrollment during the special enrollment period and the need for health insurance spurred by pandemic-related job loss has encouraged insurance giant...Arizona News
The first COVID-19 vaccines have been shipped and are now in the process of being administered to frontline healthcare workers and other high-priority members of the public. Additionally, the first over-the-counter self-administered COVID-19 tests have passed Food and Drug Administration authorization and will now move to the...Arizona News
Arizona suffered a dramatic outbreak of COVID-19 in June, the effects of which were felt throughout July. This week, cases appear to be subsiding, but the state has other complications that may cause more difficulties on the path to becoming COVID-19 free.
A story from CNN last week said that John’s Hopkins University data...Arizona News
On Monday the Justice department gave the $52 billion merger between Cigna and Express Scripts a green light. The health insurance giant and massive pharmacy benefits manager aim to cut costs of care.
The deal passed a shareholder vote toward the end of August but the DOJ's vote was the last major obstacle to clear, all that...
Attention focused after a former Aetna medical director admitted he never reviewed patient medical records when deciding whether to authorize treatment.
California Insurance Commissioner Dave Jones confirmed he is launching an investigation into Aetna's processes in denying claims and requests for prior authorization for care, as...
The potential merger between CVS and Aetna could be worth more than $66 billion.
The online retailer Amazon's flirtation with the pharmacy business has been raised as a factor in the merger. But many industry experts say CVS and Aetna have another huge competitor on their minds: UnitedHealth Group. Kaiser Health News quotes Ana Gupte,...
