Daffodil Health Launches No Surprises Act Dispute Management Solution
Daffodil Health launched an AI-powered solution to help payers manage No Surprises Act disputes by automating claims review, negotiations and arbitration workflows.
Included Health to Acquire Firefly Health to Expand Alternative Health Plan Offering for Employers
Included Health announced plans to acquire Firefly Health to accelerate its alternative health plan strategy for employers.
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The Healthcare Payments Industry Faces a Perception Challenge
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
A Prescription for Drug Costs: Inject Transparency and Improve Accessibility
Drug spending continues to grow, but that doesn’t mean that everyone is getting the medicines that they need. A panel at MedCity News’ Bullseye event discussed the evolution of the prescription drug marketplace.
$10B M&A Deal Pays Off With GSK’s First Lung Cancer Drug Approval
GSK drug Jideytro received FDA approval for treating advanced cases of non-small cell lung cancer driven by ROS1 alterations. This molecule came from Nuvalent, which GSK recently acquired for $10.6 billion.
Merck Pill Becomes First Oral Option in Growing Class of Cholesterol-Lowering Drugs
Merck’s Lipfendra is the first FDA-approved pill in the class of cholesterol-lowering drugs called PCSK9 inhibitors. While peptides are typically injected, Lipfendra is a macrocyclic peptide designed for formulation as an oral drug.
Healthcare Groups Praise Unanimous Committee Approval of MA Prior Auth Bill
The House Ways and Means Committee unanimously advanced a bill to reform Medicare Advantage prior authorization requirements.
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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.
Celcuity’s First-in-Class Drug Gets FDA Approval in Most Common Type of Breast Cancer
Celcuity drug Revtorpyk is now approved for advanced cases of the most common type of breast cancer that do not harbor a certain mutation. The intravenously infused medicine is first in a new drug class that addresses a pathway associated with many cancers.
Coalition Urges Policymakers to Reject No Surprises Act Enforcement Bill
The Coalition Against Surprise Medical Billing launched a campaign opposing the No Surprises Act Enforcement Act, arguing it would worsen IDR process abuse.
Does CMS Know What It Is Doing With Its GLP-1 Obesity Coverage Pilot?
CMS’s new GLP-1 Bridge program expands Medicare access to obesity drugs but raises concerns about cost, supply and implementation challenges.
Handspring Snags $19M to Fix the “Missing Middle” of Youth Mental Health Care
Handspring raised $19 million in Series B funding this week to expand its pediatric mental health care model nationwide. The company treats the full spectrum of acuity so children are matched to the level of care they actually need, rather than defaulting to the most intensive — and expensive — option available.
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.
ACA Marketplace Insurers Propose 14% Median Premium Increase in 2027
KFF found that ACA Marketplace insurers are proposing a median 14% premium increase for 2027, driven by rising healthcare costs and the expiration of enhanced premium tax credits.
Vera Therapeutics’ First-in-Class Kidney Disease Drug Lands Speedy FDA Approval
FDA approval of Vera Therapeutics’ Trutakna makes it first in a new class of medicines designed to block two targets to treat immunoglobulin A nephropathy, an autoimmune disease that can progress to end-stage renal failure. Competition looms from Vertex Pharmaceuticals, on track to receive a November regulatory decision for a drug designed to block the same two proteins.
Pearl Health Lands $110M to Support Value-Based Care for Medicare Patients
Pearl's $110 million raise includes a $50 million equity investment led by Andreessen Horowitz with participation from Viking Global Investors, AlleyCorp and Ulysses Capital, as well as a $60 million debt facility led by Trinity Capital.
Elevance Sues CMS Over Star Ratings, Seeks Same Recalculation Applied to Clover
Elevance filed a lawsuit last week against the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, alleging that CMS unlawfully refused to recalculate Elevance's 2026 Medicare Advantage Star Ratings on the same basis that it recently recalculated Clover Health's ratings after a court ruling.
What to Know About CMS’ New Proposed Outpatient Payment Rule
CMS published its proposed 2027 outpatient payment rule, including a 2.4% base rate increase alongside steep cuts to 340B drug payments and an expansion of site-neutral payment to off-campus imaging services. Provider groups warn that these changes would push many hospitals' payments into negative territory.