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CMS should take stronger stance on hospital pricing compliance: GAO
The CMS fails to check hospitals’ pricing data for accuracy and completeness, raising questions about whether the data can be used as intended to help payers and patients shop for services, according to the government agency.
UnitedHealth sues CMS over Medicare Advantage star ratings
A handful of plans owned by the nation’s largest MA payer are the latest to ask the court to help raise their valuable quality scores.
Texas sues major PBMs, pharma companies over high insulin prices
The litigation comes as pharmacy benefit managers Express Scripts, CVS Caremark and Optum Rx face growing criticism over their role in high drug costs — including a recent lawsuit from the Federal Trade Commission.
Medicare tweaks rules for second round of drug price talks
The agency will offer earlier meetings with drugmakers as well as solicit more patient feedback on the process.
Lawmakers urge Biden administration to extend telehealth prescribing flexibilities for opioid use disorder
A bipartisan group of two dozen representatives pushed officials to preserve the pandemic-era prescribing changes for buprenorphine, arguing telehealth increases access and prevents overdoses.
CHS offloads two North Carolina hospitals to Iredell Health
The sale offers a lifeline for struggling Davis Regional Psychiatric Hospital, which stakeholders worried could close after CHS’ deal to sell the facility to Novant Health fell through in June.
Humana’s Medicare Advantage dilemma worsens amid precipitous drop in 2025 star ratings
Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this year, the insurer disclosed Wednesday. The downgrade could wipe out Humana’s profits in 2026.
Teladoc COO to depart at year end
Mike Waters’ resignation comes after other leadership changes at the telehealth vendor, including the departure of Teladoc’s former CEO this spring.
Blue Shield of California sidesteps PBMs with new Humira biosimilar deal
It’s the first time this type of model has been used to bring a Humira biosimilar to market, according to the insurer — and it yields a much lower cost than both the brand-name version of the drug and its biologic copycats.