On March 24, 2025, the Federal Risk and Authorization Management Program (“FedRAMP”) announced a major overhaul of the ...

For the first time in 15 years, employment across the major health insurance companies fell last year, according to a Modern Healthcare analysis.

Health plans often limit physical therapy to 20 or 30 sessions, even for people who may need months of treatment, multiple ...

A bill to reform prior authorization requirements for Medicare Advantage (MA) – a massive burden that nursing home operators have been trying to change ...

The PBM is pivoting to a cost-based reimbursement model, which it says will reduce variation in how pharmacies are paid.

The PBM also announced that it will make the pharmacy experience simpler for consumers with chronic conditions by eliminating ...

The changes come as pharmacy benefit managers face scrutiny for how they require doctors and patients to seek its approval for certain treatments and drugs.

Optum Rx's new cost-based program uses an internal algorithm that leverages multiple available industry data sources, such as ...

“We better understand when those changes come,” McDaniel said ... House Bill 695 also reinstates prior authorization requirements for Medicaid recipients utilizing behavioral health ...

Optum Rx has announced that it will align payment models more closely to the costs pharmacies may face due to manufacturer pricing actions. The press release stated that this change will positively ...

UnitedHealth Group's pharmacy benefit manager, Optum Rx, said on Wednesday it would ease requirements to get insurance authorization when renewing prescriptions on about 80 drugs, aiming to reduce ...

The PBM plans to stop requiring coverage reauthorization for about 80 drugs, including Vertex’s cystic fibrosis medicines and ...