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September 28, 2026

Takeaways from the most recent news in the technology and policies shaping healthcare.

Payers

PBMs Become Rare Bipartisan Target in Washington and States

By Healthcare Technology News ·

Pharmacy benefit managers have found something unusual in polarized Washington: bipartisan agreement that they are a problem. According to KFF Health News, conservative Republicans and Democrats are lining up behind proposals to curb the power of PBMs, the middlemen who negotiate drug prices between manufacturers, insurers, and pharmacies.

The boldest idea would bar companies that own a PBM from also owning retail pharmacies, directly targeting vertically integrated giants like CVS Health, which owns both Caremark and thousands of drugstores. Two states have already enacted such restrictions, KFF reports, and a federal version has attracted prominent sponsors from both parties. The logic uniting them: PBMs use their market position to steer patients, squeeze independent pharmacies, and obscure where drug dollars actually go.

In practice, forced divestiture would reshape the business models of the largest players, which also include Cigna's Express Scripts and UnitedHealth's Optum Rx. Whether the federal effort passes remains uncertain, but the political consensus signals mounting pressure on an industry long shielded by its complexity.

Sources

More in Payers

Payers

Payer AI Is Driving Up the Hidden RCM Tax on Providers

Payer AI is accelerating claim denials and underpayments, fueling a multi-billion dollar cost to providers that some call the RCM Tax.

Why it matters: As insurers automate claim denials, providers that fail to modernize their revenue cycle risk losing significant revenue to rework and unappealed claims.

Payers

Judge Sends Ballad Health's UnitedHealth MA Suit to Arbitration

A federal judge dismissed Ballad Health's Medicare Advantage lawsuit against UnitedHealth, ordering the payment dispute into arbitration.

Why it matters: Arbitration clauses in payer contracts can quietly steer provider-insurer disputes out of court, shaping how health systems fight Medicare Advantage denials.

Payers

Medicare Advantage Plans Rethink Post-Discharge Care Transitions

Medicare Advantage plans are refocusing on the post-discharge period to reduce readmissions and protect Star Ratings.

Why it matters: Star Ratings drive billions in bonus payments and enrollment, and better care transitions are becoming a key way plans defend those scores.