More than 350,000 people in Massachusetts will begin receiving health insurance rebates in September. State insurance regulators announced Tuesday that the rebates will total $75.6 million and benefit people covered by individual or small employer plans issued by five insurance carriers. In 2024, a similar round of rebates totaled $51.6 million. The rebates are required when an insurance carrier's average medical loss ratio over a three-year period falls below the state threshold that requires insurers to spend at least 88% of premiums on health care services for individuals and small group policyholders.
Eversana has agreed to acquire Waltz Health in a deal that could reshape the pharmacy benefits ecosystem in the U.S. The combined company, valued at around $6 billion, will remain privately held and be led by Mark Thierer, who co-founded Waltz and previously ran Catamaran, a pharmacy benefits manager acquired by UnitedHealth Group for roughly $13 billion in 2015.
Blue Shield of California has named CFO and interim CEO Mike Stuart as its new president and CEO. CFO of the nonprofit health plan since 2022, Stuart brings more than two decades of leadership experience in healthcare to the job.
DOJ's criminal division is digging into business practices at UnitedHealth Group's pharmacy benefit manager, Optum Rx, Bloomberg News reported on Tuesday, citing people familiar with the matter. Under an ongoing probe into the company's operations, the investigators are looking into its prescription management services and how it reimburses its own doctors.
Akron's Summa Health will stop scheduling appointments for people with out-of-network and non-contracted insurance plans, effective Monday, Sept. 1, the health system announced. The change is meant to protect Summa from spending resources trying to collect payment from out-of-network health insurers, while also protecting out-of-network patients from high hospital bills, Summa said in an email. The new policy includes Summa Health Medical Group and walk-in services at Summa Health Urgent Care Centers and laboratory and radiology services. The policy does not apply to emergency services or emergency labor and delivery treatment.