The two said they’ve been negotiating terms for eight months. Sticking points include denied claims and coverage disputes, with both the insurer and health system pointing fingers.

Bloomberg said the pharmacy benefit manager is being probed as part of a larger look into the “prescription management services” of UnitedHealth. According to sources, this may be related to an ongoing investigation into alleged instances of Medicare Advantage upcoding.

A merger between Eversana and Waltz Health will create a new entity that CEO Mark Thierer says will upend the “existing oligopoly that I helped build.”

The settlement reached in October 2024 has been finalized. A fund is being set up for the estimated 3 million claimants, as BCBS pledges to reform its BlueCard health plans.

The initial incident happened in April. Since that time, the notorious cybercrime cell Interlock has claimed responsibility. A data dump from the breach was put up for sale on the dark web.

Many make federal reimbursement plans into an issue about high-paid specialists complaining about pay cuts, but these fees also compensate nurses, technicians, support staff and administrators. Payment keeps the doors of brick-and-mortar medical practices open, MGMA warns.

No single CMS strategy has proven an inarguable success at delivering significant cost savings while optimizing patient outcomes and minimizing clinical risks. Two researchers think they’ve found a way. 

The American Pharmacists Association is being labeled as a biased special interest group under new rules for the CDC Advisory Committee on Immunization Practices, a move that seems to be politically motivated when APhA did not support changes in COVID vaccines earlier this year. 

Summa Health said the change will take effect Sept. 1, with the two-hospital network ceasing scheduling of appointments for this consumer segment.

Eli Lilly and Company is back with even more positive data on orforglipron, its oral GLP-1 receptor agonist. The company says it is "moving with urgency" toward gaining key regulatory approvals and getting the drug in the hands of patients.