Fierce Healthcare

As October officially gets underway, health insurers are gearing up for the start of Medicare's annual enrollment period.

The White House announced Tuesday it was rolling out a direct-to-consumer website where individuals can buy prescription medications at discounted prices.

John D’Angelo, M.D., who stepped into the CEO role on Oct. 1, discusses Northwell's strategy for macroeconomic challenges like decreasing insurance coverage, technology efficiencies and his predecessor's legacy.

Non-viral genetic medicine—the next frontier for non–muscle invasive bladder cancer that may address burdens faced by patients and healthcare providers.

The offering, available in person and virtually, includes hormone therapies and nonhormonal treatments as well as vaginal treatments and lifestyle strategies. Millie currently has two clinics in the Bay Area.

In this episode of "Podnosis," we examine the push to modernize payment integrity and what it means for payers, providers and patients.

Insurers that own medical clinics may be able to use these relationships to game medical loss ratio requirements, according to a new analysis.

Visana Health plans to use the funding to further expand its clinical offerings and beef up its tech infrastructure.

In line with the Trump administration's "most favored nation" drug pricing push, Pfizer is lining up what appears to be discounts for its medicines through Medicaid and DTC sales channels. The company will also invest $70 billion in U.S. manufacturing and R&D over the next several years.

Ambience Healthcare rolled out an ICD-10 clinical document integrity assistant for inpatient care, aiming to help hospitalists document more accurate clinical notes and reduce billing and coding issues downstream.

Medicare virtual care flexibilities will lapse Oct. 1, but providers could still use the modality with hopes Congress offers a retroactive fix.

Major medical groups are urging the Trump administration to exempt foreign healthcare workers from new H-1B visa fees, saying the steep charge will exacerbate a clinician shortage and hit rural and underserved areas particularly hard.

Universal Health Services said it plans to appeal the case brought by a Prime Healthcare affiliate and expects to pay substantially less due to Nevada statutory limitations on punitive damages.

Enrollment in Medicare Advantage has climbed steadily over the past decade, and, of late, a key area of focus in this market has been around special needs plans.

A moratorium on state AI laws died over the summer in Congress, and in recent months Sen. Ted Cruz and the White House have advocated for AI sandboxes at the federal level to exempt startups from "burdensome regulation." As advocates shrug at the sandbox proposal, Cruz says a state-level moratorium is still on the table.

Wisp will list Stripes’ signature over-the-counter products for menopause on its website, while Stripes will offer its customers a discount for Wisp.

The Trump administration projects average Medicare Advantage premiums will decline slightly for the 2026 plan year.

The latest projection from the Urban Institute and the Robert Wood Johnson Foundation also outlines a $7.7 billion increase in uncompensated care demand and comes amid a political standoff on the subsidies.

Medicare Advantage insurers scored a major court win this week when a federal judge struck down a Biden-era regulation that beefed up risk adjustment audits in the program.

State government leaders moved quickly on the bill passed this week, citing an "immediate shortfall" providers faced this year due to increased care for uninsured and underinsured patients.