TennCare, the large Medicaid managed care program, recently awarded two new contracts to health plans to manage the care for enrollees in west and east portions of the state. The contracts went to Ame…
Maryland has become one of the first states to pass laws regulating the licensing and transparency of pharmacy benefits managers operating in the state. The bills were supported by the Pharmaceutical…
Passage of the state's new Cover Florida program is likely to put some of the 3.8 million uninsured residents into health insurance, but critics question how much help the low-premium/limited bene…
New York's proposal to curb “fourth tier” drug pricing has health plans alarmed that lawmakers might curb their ability to structure health benefits, particularly in cost-sharing for exp…
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…
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…
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…
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…