Policy & Regulations

This channel includes news coverage of healthcare policy and regulations set by Congress, the states, Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), U.S. Food and Drug Administration (FDA), and medical associations and societies. 

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Employers clamp down on rising healthcare benefit costs

Healthcare benefit costs in the U.S. are expected to rise 5% next year, causing large employers to up their efforts to save, according to a survey from the National Business Group on Health.

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Tufts, Harvard health plans to merge

Two institutional-based health plans in New England have announced their plans to merge.

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PBMs passed on 99% of rebates

Pharmacy benefit managers (PBMs) are only keeping less than 1% of rebates in the Medicare Part D program, passing on the rest of drug savings to plan sponsors, a report from the Government Accountability Office (GAO) found.

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How Vox analyzed and explained the high prices in emergency departments

When Sarah Kliff, healthcare reporter for Vox, saw an emergency department bill charging more than $600 for an encounter that ended with a band-aid, she and the media company undertook a year-long project to explore as many ED bills as possible.

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CMS Obamacare report reveals drop in unsubsidized enrollment

Enrollment of people who are ineligible for subsidies on the individual healthcare market appears to be slowing down, according to a recent report from CMS.

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Hospital, physician prices jumped over the last 5 years

Hospital prices continue to rise and are a major contributor to overall spending in the healthcare sector, which is expected to hit $6 trillion by 2027.

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Out-of-network billing rises, leaving patients with surprise expenses

Out-of-network billing in emergency departments has risen over the last few years, often leaving patients with surprise expenses even when they have insurance coverage and receive care from an in-network hospital.

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Eli Lilly’s half-price insulin hard to obtain

After drug manufacturer Eli Lilly introduced a half-priced insulin product to the U.S. market, patients are having trouble getting the medication, the Financial Times reported.

Around the web

CMS finalized a significant policy change when it increased the Medicare payments hospitals receive for performing CCTA exams. What, exactly, does the update mean for cardiologists, billing specialists and other hospital employees?

Stryker, a global medtech company based out of Michigan, has kicked off 2025 with a bit of excitement. The company says Inari’s peripheral vascular portfolio is highly complementary to its own neurovascular portfolio.

RBMA President Peter Moffatt discusses declining reimbursement rates, recruiting challenges and the role of artificial intelligence in transforming the industry.