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Wednesday, June 10 · 3 stories
- Industry
U.S. Drug Shortages Fell 23% in 2024 Despite Ongoing Systemic Supply Issues
Prescription drug shortages in the United States decreased by 23% in 2024 according to a new analysis, but systemic supply chain problems persist. The analysis identified ongoing structural vulnerabilities in pharmaceutical manufacturing and distribution that continue to affect medication availability. While the overall number of shortages declined, the duration and severity of certain shortages worsened. For Medicaid managed care organizations, drug shortages create formulary management challenges, increase member access barriers, and complicate pharmacy benefit administration when preferred products become unavailable.
Monday, June 8 · 7 stories
- Industry
Eli Lilly 340B Deadline Passes, Noncompliant Hospitals Lose Discounts
Eli Lilly's June 1 deadline for hospitals to submit claims data to maintain 340B drug discounts has passed without HRSA intervention. Hospitals that failed to comply with Lilly's data submission requirements will lose access to discounted pricing on covered drugs. HRSA has not responded to requests from hospital and pharmacy groups to intervene in the dispute. The action affects hospitals participating in the 340B program that purchase Lilly medications.
- Industry
Three Hospital Closures Reported in Early 2026, Down from 13 Year Prior
Three U.S. hospitals and emergency departments closed in early 2026, compared to 13 at the same point in 2025. Total closures in 2025 reached 23, nearly matching the 25 reported in 2024. The article suggests the early 2026 slowdown may not indicate structural improvement in hospital financial stability. The trend continues a multi-year pattern of hospital closures driven by financial pressures.
- Industry
NASHP Hosts Webinar on Rural Health Payment Reform Models
The National Academy for State Health Policy (NASHP) will hold a webinar on June 16, 2026, from 3–4 p.m. ET focusing on payment reform strategies for rural health settings. The session will explore collaborative learning opportunities around alternative payment models designed for rural providers. Rural health care delivery intersects with Medicaid managed care in states where MCOs serve rural populations or where rural providers participate in value-based payment arrangements.
- Industry
Health Economist Calls for New Payment Infrastructure for Gene Therapies
Health economist William Padula argues that high-cost gene therapies, including treatments costing $2 million or more, require new financing models to enable patient access. The commentary asserts that the barrier to deploying curative therapies is not scientific but financial and infrastructural. Padula contends that existing payment systems are ill-equipped to handle the upfront costs of one-time curative treatments. The piece calls for innovative financing mechanisms to bridge the gap between therapeutic breakthroughs and patient access.
- Industry
ADA Conference Highlights Obesity Drug Competition and Clinical Practice Gaps
The American Diabetes Association's annual conference featured industry discussions on the competitive landscape for GLP-1 obesity medications and identified clinical blind spots in diabetes care delivery. The conference addressed how pharmaceutical competition is shaping market access and pricing dynamics for widely-used medications including semaglutide and tirzepatide. For Medicaid managed care organizations, these developments directly affect formulary strategy, prior authorization protocols, and budget forecasting for one of the fastest-growing drug spending categories.
- Industry
Trump Administration Adds 160 Drugs to TrumpRx Direct-to-Consumer Platform
President Trump announced Friday that TrumpRx.gov will add 160 prescription medications to its direct-to-consumer platform, bringing the total to over 800 drugs available at discounted prices. This marks the second expansion of the initiative in two months. The platform sells drugs directly to consumers, bypassing traditional pharmacy channels. The announcement did not specify which drugs were added or provide details about pricing structures or manufacturer participation.
- Industry
20% of U.S. Adults Report Denial of Doctor-Recommended Care
A new Commonwealth Fund study found that one in five U.S. adults were denied doctor-recommended care, leading to deteriorating health outcomes and financial strain. The research highlights increasing patient frustration with claims review processes and prior authorization barriers. Insurers maintain their utilization management protocols are medically appropriate. The findings come as regulatory scrutiny of managed care denial practices intensifies at both federal and state levels.
Friday, June 5 · 1 story
- Industry · NC
Novant Health Reports 1,595 Bed Days Saved Through Hospital-at-Home Program
Novant Health's 19-hospital system launched a hospital-at-home program at Hanover Regional Medical Center in Wilmington, North Carolina, saving 1,595 inpatient bed days. The health system is advocating for expanded private payer coverage of the care model and seeking federal legislation to make hospital-at-home a permanent option beyond current emergency waivers. The program allows acute-care patients to receive hospital-level services in their homes, reducing facility capacity strain while maintaining care quality.
Thursday, June 4 · 1 story
- Industry · NY
Westchester Medical Center Partners with MVP Health Care on Care Coordination
Westchester Medical Center Health Network in New York has launched a partnership with MVP Health Care to improve care coordination for hospitalized patients and during discharge transitions. MVP clinical care managers will be embedded in hospital care teams and will continue supporting members after they return home. The partnership aims to reduce readmissions and improve care continuity. The arrangement reflects growing collaboration between health systems and payers on care transition programs.
Wednesday, June 3 · 1 story
- Industry
Providers and Insurers Deploy AI Tools for Prior Authorization and Claims Battles
Healthcare providers and insurers are increasingly using artificial intelligence to automate prior authorization requests and claims denials, creating an escalating technological arms race in medical billing. Providers use AI to generate documentation and appeals, while payers deploy AI to review and deny claims at scale. The automation may reduce administrative burden but also risks accelerating denials without human clinical judgment. This trend affects Medicaid managed care organizations that already face scrutiny over prior authorization delays and denial rates.
Tuesday, June 2 · 2 stories
- Industry
Eli Lilly Threatens to Cut 340B Discounts for Hospitals Refusing Data Sharing
Eli Lilly has issued an ultimatum to certain 340B hospitals requiring them to share data proving they are not duplicating drug discounts by Monday or face loss of 340B pricing. The pharmaceutical company claims some hospitals refuse to provide documentation showing compliance with program requirements prohibiting duplicate Medicaid and 340B discounts on the same claim. Hospitals are pushing back and requesting federal government intervention. The dispute centers on manufacturer attempts to limit 340B discounts amid concerns about program integrity and duplicate discounting.
- Industry · NC
Trump Rural Health Fund Excludes Closed Hospital Reopening Efforts
A proposed $50 billion rural health funding package championed by Congressional Republicans is not expected to support efforts to reopen closed rural hospitals, including Martin County, North Carolina's shuttered facility. The funding structure appears focused on operational support for existing facilities rather than capital investment for reopening closed hospitals. Rural hospital closures have accelerated over the past decade, leaving gaps in access to emergency and inpatient services. The exclusion raises questions about how federal rural health investment will address communities that have already lost their hospitals.
Monday, June 1 · 4 stories
- Industry
Telehealth Companies Expand GLP-1 Access Amid Safety and Screening Concerns
Telehealth platforms have rapidly scaled access to GLP-1 weight loss medications in response to surging patient demand. Researchers and physicians have raised concerns that some online providers may not adequately screen patients for contraindications or provide appropriate clinical monitoring during treatment. The safety questions emerge as telehealth prescribing of these high-cost medications expands outside traditional clinical settings. The controversy affects how managed care organizations evaluate telehealth vendor networks and pharmacy benefit management for GLP-1 drugs.
- Industry · MN
Minnesota Hospitals Provide Limited Charity Care Despite Growing Uninsured Population
An investigation of Minnesota hospital data reveals most facilities provide minimal financial assistance to uninsured patients and create barriers to accessing charity care programs. The analysis examined hospital charity care spending and program accessibility as the state's uninsured population grows. The findings highlight systemic gaps in the healthcare safety net that affect uninsured individuals who may be eligible for Medicaid but face enrollment barriers or fall into coverage gaps. These charity care shortfalls increase the likelihood that uninsured patients delay care or accumulate medical debt, potentially affecting downstream Medicaid enrollment and emergency department utilization patterns.
- Industry
Gene Therapy Medications Pose Financial Challenges for Health Plans
Metabolic gene therapies are creating new financial pressures for health plans and benefits managers. These treatments offer clinical benefits for patients with serious conditions but carry high costs that require specialized coverage and payment strategies. The article discusses how plans must prepare benefits structures to manage these emerging high-cost therapies. No specific implementation timeline or regulatory action is described.
- Industry
Home-Based Care Providers Diversify Payer Mix Amid Reimbursement Pressure
Home-based care providers are restructuring their business models in response to sustained reimbursement cuts and policy changes across payers. Providers report cumulative financial strain from incremental rate reductions and inconsistent payment structures. In response, agencies are diversifying their payer portfolios and forming local partnerships to maintain financial viability. These strategic shifts are occurring now as providers adapt to what industry leaders describe as accumulating incremental cuts rather than single policy changes.
Thursday, May 28 · 9 stories
- Industry
CVS Restores Lilly Obesity Drug to Formularies After Prior Removal
CVS Health has returned Eli Lilly's obesity medication to its formularies after previously removing it. This formulary reinstatement affects Medicaid managed care organizations that contract with CVS Caremark for pharmacy benefit management services, potentially expanding access to GLP-1 medications for Medicaid enrollees. The decision reverses a prior coverage restriction and may influence pharmacy spending and prior authorization protocols. Managed care plans should review their pharmacy contracts and assess budget impact from potential increased utilization of high-cost obesity treatments.
- Industry
Health Care REITs Shift Investment Focus from Nursing Homes to Senior Housing Communities
Health care real estate investment trusts are increasingly pivoting away from nursing home investments toward senior housing communities offering independent living options. The shift reflects broader real estate market trends over the past two years, with potential implications for hospital system partnerships in the senior housing sector. The article outlines strategic considerations for hospital systems exploring senior housing collaborations. This trend may affect Medicaid managed care organizations with long-term services and supports responsibilities, particularly those managing dual-eligible populations transitioning between care settings.
- Industry
CMS Pauses Hospice, Home Health Medicare Enrollments in Fraud Crackdown
CMS has paused new Medicare enrollments for hospice and home health agencies as part of a fraud prevention initiative. The enrollment moratorium affects providers seeking to enter Medicare in these categories while CMS implements enhanced screening measures. The action reflects heightened federal scrutiny of post-acute care billing practices. Medicaid managed care plans with Medicare-Medicaid dual eligible members or LTSS carved-in arrangements may see network disruptions if moratorium extends or existing providers face termination.