Aetna is among national insurers working to chip away at the market dominance of the Regence Group and Premera Blue Cross in Oregon and Washington. Oregon's Medicaid expansion program, called Oreg…
Texas' health plans have long benefitted from the Lone Star State's mandatory generic dispensing law, but have gone beyond that to achieve significant generic utilization and subsequent saving…
Massachusetts is at a crossroads with its Commonwealth Care and Choice programs with enrollment exceeding expectations but costs coming in over earlier estimates. The Massachusetts Legislature is cons…
Two Louisiana-based health plans – Peoples Health and Vantage Health Plans – are succeeding in the Medicare Advantage space despite competition from larger, national plans. The three managed care heal…
If being Number Two means you try harder, then that explains the expansion and new product efforts by Medica and Health Partners, the second- and third-place health plans in Minnesota respectively. Bo…
Kaiser Permanente is preparing to make a huge strategic leap beyond its gatekeeper HMO roots by rolling out an administrative services only (ASO) product offering to large employers. The Department of…
Managed care plans participating in one of the nation's largest Medicaid managed care programs – in Ohio – are experiencing difficulties in maintaining their profit margins, highlighted by the dep…
Humana's purchase of OSF Health Plans will likely beef up the plan's presence in downstate Illinois, where Blue Cross Blue Shield and UnitedHealth dominate. Illinois health plans are adopting…
Cariten Healthcare, a small provider-owned health plan based in Knoxville, walked away from the crowded field of contenders for the east Tennessee region TennCare contract, a contract viewed as highly…
A much-awaited bidding process for managed care plans to serve Medicaid beneficiaries in Washington, D.C., resulted in the selection of its three existing MCOs, as well as Unison Health Plan, which is…
Pennsylvania health plans have seen great success in managing their pharmacy costs – through encouraging the use of generics, aggressive formulary management, and copay structures. But the conundrum p…
Blue Cross and Blue Shield of North Carolina is upping the ante on transparency with its new Health Cost Estimator by offering contracted prices instead of provider charges, and by estimating the cost…
Wisconsin is joining the ranks of states who are carving out the pharmacy benefits in their Medicaid and other health programs in an attempt to maximize rebates from drug manufacturers. And though the…
Consumer-driven health plans are beginning to make inroads in the small-group market of Kansas-Missouri. The largest plan in Missouri, Anthem Blue Cross and Blue Shield, has a significant portion of i…
The rapid growth of Florida's population is creating opportunities for the state's health insurers, who are targeting second-tier metropolitan regions such as Naples and Marco Island for new p…