KFF: Insurers Denied 12%-18% of Prior Authorization Requests in 2025
KFF found that insurers denied 12%-18% of standard prior authorization requests in 2025, with significant variation among insurers and gaps in transparency.
Slate Medicines’ Merger and $245M Private Placement Fuel Mission in Migraine
Migraine drugs developer Slate Medicines is going public in a reverse merger with Fulcrum Therapeutics. The biotech’s lead antibody drug blocks two novel migraine targets, offering the potential for better efficacy compared to other next-generation migraine drugs in R&D.
Where Will AI Deployment Benefit Payers the Most?
We are taking a look at how health insurers are using AI, defining success, and managing cybersecurity risks. Give us your opinions by completing our brief, anonymous survey.
The Rise of Consumer Diagnostics and Emerging Trends
Consumer diagnostics will be one of several discussions at the INVEST Digital Health conference focused on power shifting to the consumer in healthcare. The conference is scheduled for October 29 in Dallas at Pegasus Park, in partnership with Health Wildcatters.
Healthcare Is Deploying AI Tools — It’s Not Ready for AI Colleagues
Most healthcare organizations are experimenting with AI. Few are preparing to manage AI agents as participants in everyday healthcare workflows.
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How Payers and Health Plans Think of Identity and the Risks of Fragmented Data
A recent webinar, sponsored by Verato, offered insights from executives at SCAN Health Plan and the Alliance of Community Health Plans on a wide range of tech challenges in healthcare from fragmented data to technology architecture to patient identity.
The Reimbursement Challenges Hurting Women’s Health Companies, Per Milken Institute
Women’s health startups should plan for reimbursement early, as limited research and evidence can make securing coverage difficult, a new report explains.
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Closing the Quality-Affordability Gap in Workplace Mental Health
In an interview, Kyan Health Co-Founder and Chief Commercial Officer Konstantin Struck discussed how Kyan gives mid-market and enterprise employers access to premium workforce mental healthcare, at a price point that is affordable.
Vogenx IPO Raises $81M for Trial in Metabolic Disease With No Approved Drugs
Vogenx’s mizagliflozin is heading into Phase 2b testing for post-bariatric hypoglycemia (PBH). Amylyx Pharmaceuticals and Recordati are developing injectable peptide drugs for this metabolic disorder, but Vogenx aims to stand apart by offering patients a different mechanism of action and oral dosing.
Better Models Won’t Fix Pharma’s AI Problem — Better Terminology Will
The bottleneck in AI-enabled real-world data analysis is not computation, model architecture, or training data volume. It is the semantic layer over which the AI is trying to reason – the place where precise clinical meaning lives.
The True Cost of Focusing on Cost Instead of Cost-Effectiveness
When payors consider only the cost of the medication and not the cost and risk to the patient, doctor, and healthcare system, the irony is that not only is this terrible for patient health, it can be more costly in the end.
Patient Group Sues AMA, Says the Org Shouldn’t Be Charging for CPT Codes
PatientRightsAdvocate.org sued the American Medical Association this week, arguing the trade group has no valid copyright over the CPT codes that providers must use to bill for care. It follows a public letter Senator Bill Cassidy sent to the AMA last year accusing it of "abus[ing] [its] government-backed monopoly by charging exorbitant fees to anyone using the CPT code set."
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From Blind Spots to Better Outcomes: How SNF Data Transparency Strengthens LTSS
What if health plans could identify member decline before an avoidable hospitalization occurs? Real-time clinical visibility into long-stay SNF members uncovers risk earlier and drives better outcomes.
Aligned Marketplace Secures $20M for Advanced Primary Care Marketplace
Venrock led Aligned Marketplace's Series A round. In total, the company has raised $31 million to date.
Bristol Myers Squibb Protein Degrader Wins First-in-Class FDA Nod in Multiple Myeloma
Bristol Myers Squibb’s Zenbexus is the first FDA-approved drug in a new class of cancer drugs called CELMoDs. The pharma company is positioning this molecule as a successor to its legacy products for multiple myeloma.
Healthcare Keeps Buying AI. But Nobody’s Building the Workforce to Run It.
Most younger professionals entering the workforce have little visibility into interoperability, digital health infrastructure, or healthcare data architecture as career pathways.
Appeals Court Sides with Providers in No Surprises Act Pay Dispute
A court ruling struck down key parts of how regulators calculate the No Surprises Act's qualifying payment amount, siding with the Texas Medical Association's argument that the formula has historically favored payers in arbitration.
Cotiviti Launches AI Solution to Address Coordination of Benefits Issues
Cotiviti launched an AI-powered coordination of benefits solution that uses enrollment data to identify and resolve coverage issues before claims are submitted.