Tennessee lawmakers recently passed a bill banning PBMs from owning pharmacies in the state, though like a similar Arkansas law, it is expected to face legal challenges if enacted.

The post Will Tennessee’s PBM Bill Face the Same Fate as Arkansas’ Law? appeared first on MedCity News.

Benefits leaders have become increasingly sophisticated in managing pharmacy spend and high-cost claims. MSK deserves similar strategic attention – not only because it is expensive, but because it is largely preventable.

The post Musculoskeletal Disorders Are Draining Employer Health Budgets — The Workplace Itself May Be the Cause appeared first on MedCity News.

Lawmakers introduced the Medicare Advantage Improvement Act of 2026 to tighten prior authorization rules, boost transparency and curb practices that delay care.

The post Bipartisan Bill Seeks to Strengthen Oversight of Medicare Advantage appeared first on MedCity News.

This is forcing brokers to rethink how they serve clients and how their businesses continue to grow without sacrificing service.

The post As Health Costs Hit Record Highs, Brokers Face a Structural Test appeared first on MedCity News.

SCAN Health Plan CEO Sachin Jain urged brokers to abandon for-profit plans that treat them poorly, but one broker argued they often can’t because dominant players like UnitedHealth Group control so much of the healthcare system.

The post SCAN CEO Urges Brokers to Drop Plans That Treat Them Poorly — One Says She Has No Choice appeared first on MedCity News.

At the Medicarians Conference, Ricardo Carcas, assistant special agent in charge of the Office of Investigations, discussed cases of fraud in the ACA and how the DOJ is combatting it.

The post How the DOJ Is Tackling Fraud in the ACA Marketplace appeared first on MedCity News.

Oscar Health launched Lucie, a marketplace aimed at making healthcare more shoppable.

The post Oscar Health Seeks to Build ‘Airbnb for Healthcare’ with New Marketplace, CEO Says appeared first on MedCity News.

CMS is proposing to make its joint replacement bundled payment model mandatory nationwide. Experts say it is a logical step, but warn that mandatory participation could be challenging for hospitals to implement.

The post Expanding the CJR Model Is a Logical Step in VBC, but Implementation Challenges Remain appeared first on MedCity News.

A new report from Trilliant Health finds behavioral health demand has surged since 2018, but workforce shortages and access barriers continue to limit care.

The post Behavioral Health Demand Has Increased by 62% Since 2018. What the Industry Needs to Know appeared first on MedCity News.

Rep. Greg Murphy introduced a bill that would require out-of-pocket prescription drug spending to count toward patients’ deductibles and out-of-pocket maximums regardless of where the drugs are purchased.

The post New Bill Seeks to Lower Out-of-Pocket Drug Costs appeared first on MedCity News.

Vida Health is partnering with ŌURA to use data from the Oura Ring to provide more continuous, personalized cardiometabolic care and improve patient outcomes.

The post Vida Health Teams Up with ŌURA to Provide More Personalized Metabolic Care appeared first on MedCity News.

New research from the Elevance Health Public Policy Institute finds that higher enrollment in Medicare Advantage may be linked to lower overall Medicare spending.

The post Report: Growth in MA Is Associated With Lower Total Medicare Spending appeared first on MedCity News.

President Donald Trump’s 2027 budget proposes deep healthcare cuts, raising concerns about harm to patients and research.

The post ‘A Significant Assault on Our Health’: Healthcare Policy Leaders Condemn Trump’s Budget Proposal appeared first on MedCity News.

Health insurers have reduced prior authorizations by 11% and are continuing reforms to streamline and speed up approvals, according to an announcement from AHIP and Blue Cross Blue Shield Association.

The post Insurers have Cut Prior Auth by 11% Following Commitments appeared first on MedCity News.

Healthcare leaders can’t tell whether value-based care and Medicare Advantage are truly lowering costs. Some see promise in these models and ongoing innovations, while others say the programs haven’t delivered measurable savings and point to direct contracting as a more transparent way to control spending.

The post Do Healthcare CEOs Agree on Whether VBC and MA Actually Save Money? appeared first on MedCity News.

Yuzu’s $35 million round was led by General Catalyst and Chemistry, with participation from Anthropic’s Anthology Fund, Bain Future Back Ventures, Timeless Ventures, Lachy Groom and Neo.

The post TPA Yuzu Health Aims to Revamp Health Benefits with $35M Boost appeared first on MedCity News.

Amazon has added Berry Street to its Health Benefits Connector to help customers discover and access insurance-covered nutrition therapy services through its platform.

The post Amazon Teams Up with Berry Street to Expand Access to Nutrition Therapy appeared first on MedCity News.

In this episode, we’re joined by Dr. Barbara Levy, chief medical officer of Visana Health. We discuss the American College of Obstetricians & Gynecologists’ new clinical guidance on endometriosis.

The post MedCity FemFwd: ACOG’s New Guidelines Around Endometriosis appeared first on MedCity News.

WHOOP’S Series G round was led by Collaborative Fund and includes participation from 2PointZero Group, Qatar Investment Authority, Cristiano Ronaldo and LeBron James.

The post WHOOP Secures $575M, Reaches $10B Valuation appeared first on MedCity News.

An Urban Institute report finds that the One Big Beautiful Bill Act could cause 5–10 million people to lose Medicaid coverage by 2028, with outcomes heavily dependent on how states implement work requirements and eligibility rules.

The post State Mitigation Strategies Could Blunt Medicaid Coverage Losses appeared first on MedCity News.

Through a new partnership, consumers nationwide can access Jona’s gut microbiome test on Everlywell’s platform.

The post Everlywell, Jona Team Up to Expand Access to Gut Microbiome Test appeared first on MedCity News.

Industry leaders say the No Surprises Act is protecting patients from surprise bills, but its Independent Dispute Resolution system is being overused and exploited, driving up costs and prompting calls for reform.

The post ‘This is Crazy’: Health Experts Call for Changes to the No Surprises Act appeared first on MedCity News.

Experts are split on whether H.R. 1 Medicaid changes in 2027 will roll out gradually or on schedule.

The post Could There Be a ‘Soft Opening’ of H.R. 1 Medicaid Changes? appeared first on MedCity News.

Rising healthcare costs are a key focus for AHIP, whose CEO says the group is pushing reforms to boost competition and reduce administrative burden.

The post AHIP CEO: “We Are Laser-Focused on Affordability” appeared first on MedCity News.

Rachel Springate, general partner at Muse Capital, said the next wave of healthcare startups will be driven by consumer demand — but pure direct-to-consumer models rarely work. Companies like Midi Health, Mavida Health and Mahmee are showing a different path: starting with patients, collecting outcomes data, and integrating with clinicians, payers and the broader healthcare system.

The post Why Pure DTC Doesn’t Work in Healthcare, Per Muse Capital appeared first on MedCity News.

In a recent letter, Senate Democrats proposed lowering healthcare costs, expanding coverage and cracking down on insurance company practices.

The post 12 Senate Democrats Unveil Plan to Cut Costs, Expand Coverage appeared first on MedCity News.

An NYU Stern report links private equity in healthcare to worse outcomes and higher bankruptcy risk, calling for reforms and stronger oversight.

The post NYU Stern Report Urges Regulation of Private Equity in Healthcare appeared first on MedCity News.

Here are four perspectives from providers, patients, life science executives and healthcare technologists about ways to boost trust at a time of rapid AI deployments.

The post How to Boost Trust in Tech? 4 Perspectives from SXSW appeared first on MedCity News.

Lantern’s $30 million raise was led by Morgan Health, a JPMorganChase business unit focused on employer-sponsored healthcare, as well as Echo Health Ventures, a strategic investment platform that invests on behalf of multiple Blues health plans.

The post Lantern Secures $30M to Fuel Growth Across Employers and Health Plans appeared first on MedCity News.

[Sponsored] Zelis highlights, through a recent survey, how employers, payers, and consumers are integrating digital tools to manage healthcare costs. The findings provide a comprehensive view of the healthcare financial landscape, bringing together stakeholder perspectives, priorities and the opportunities to address them.

The post Survey on the Healthcare Financial Landscape Offers a Roadmap for Stakeholders appeared first on MedCity News.