Finances
Florida attorney general sues PBMs Express Scripts, Prime over alleged price fixing
Florida Attorney General James Uthmeier filed a lawsuit last week in state circuit court, alleging that an agreement between Cigna-owned Express Scripts and Prime Therapeutics in 2019 allowed Prime to adopt Express Scripts' lower pharmacy reimbursement rates, constituting horizontal price fixing and violating Florida's antitrust and unfair trade practices laws. The lawsuit claims this caused reimbursement rates for some pharmacies to plummet by 80%, threatening pharmacy survival and patient access to medications. Prime denied the allegations, stating its model lowers patient costs; Express Scripts did not respond. Similar lawsuits have been filed previously, with the most recent brought by nearly 5,000 independent pharmacies.
Centene taps Fannie Mae executive as CIO
Centene announced on Monday that it has appointed Bradley Bolivar, Chief Information Officer of Fannie Mae, as its new CIO, effective immediately. Bolivar brings nearly three decades of technology leadership experience and has driven AI adoption at Fannie Mae. He will succeed Brian LeClaire, who is retiring at the end of October. This move is one of several executive changes at Centene this year, following adjustments to its CFO and board members.
Sword Health to acquire Headspace
According to Massachusetts regulatory filings, Sword Health intends to acquire OrangeDot, Headspace's parent company, with the deal expected to close on September 14. Both parties stated that operations will largely continue, though some overlapping roles may be eliminated.
Employers face ‘existential reckoning’ as health costs surge
The latest survey by the Business Health Group shows that U.S. employers expect median healthcare costs to rise 9.2% in 2027, with actual spending exceeding expectations for three consecutive years and the gap widening annually. Rising hospital prices, drug costs, and deteriorating employee health are key drivers. Facing cost pressures, employers are considering cutting benefits, switching suppliers, and re-evaluating their role in the healthcare system.
‘A game changer’: UHS closes $835M Talkspace acquisition
Universal Health Services (UHS) announced the completion of its $835 million acquisition of Talkspace, with the deal officially closing on Monday. The acquisition integrates UHS's inpatient, outpatient, and virtual behavioral health services into a national closed-loop system, aiming to address workforce shortages and meet growing mental health demands. UHS expects Talkspace to generate approximately $280 million in revenue for its behavioral health division this year and slightly boost adjusted earnings per share.
Insurers want to hike small businesses’ premiums by 14% next year: KFF
A new analysis released by the health policy research organization KFF shows that insurers plan to increase median health insurance premiums in the small business group market by 14% in 2027. Amid soaring healthcare costs, surging demand for GLP-1 drugs, and the impact of the No Surprises Act, most insurers have requested increases ranging from 10% to 20%, with some even exceeding 30%.
Hinge Health expands into gastrointestinal care with $105M acquisition
Digital musculoskeletal care company Hinge Health announced on Tuesday that it has signed a definitive agreement to acquire virtual digestive care company Cylinder Health for $105 million in cash to expand gastrointestinal care services. The transaction is expected to close in the third quarter of this year, after which Hinge plans to incorporate integrated GI care into its existing MSK and migraine care programs.
Complete Health to pay $14M to settle Medicare Advantage fraud allegations
Complete Health has agreed to pay $14.1 million to settle a whistleblower lawsuit accusing it of inflating Medicare Advantage reimbursements through false diagnosis codes from 2020 to 2023. The U.S. Department of Justice stated that the settlement underscores regulators' commitment to combating profiteering in the MA program.
CVS net profit triples, health plan business performs strongly
CVS Health's second-quarter net profit approached $3 billion, roughly three times that of the same period last year, mainly driven by the strong earnings performance of its insurance unit Aetna. Despite a decline of about 600,000 total members, Aetna improved its profit margin by cutting benefits and exiting unprofitable markets. The company raised its 2026 guidance for the second time and announced a collaboration with Eli Lilly to offer more GLP-1 weight-loss drugs through CVS channels.