Regulated Markets Summit Recap

November 13, 2025

marketplace medicaid Medicare

At the 9th annual Regulated Markets Summit, Evernorth leaders and industry experts discussed challenges and opportunities in today’s complex regulatory health care environment. They provided actionable insights for key topics related to drug pricing policies, benefit design, Quality and Star Ratings and CMS audits.

Want to learn more? Please reach out to your Evernorth strategist or account team, or click here to download the recap!

legislation

Maine Ballot Initiative Underway for Universal Health Care Coverage

Through the use of a “citizen’s initiative,” efforts are underway in Maine to place on the 2026 ballot a question asking whether voters want to create state legislation to establish universal health care coverage in the state. For this to occur, at least 68,000 valid signatures must be collected by Feb. 2026. If the threshold […]
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November 13, 2025

EGWP marketplace medicaid Medicare

legislation

Iowa Regulator Seeks Clarity on Entities Impacted by PBM

On Oct. 14, Wellmark Blue Cross and Blue Shield filed a federal lawsuit against Iowa Insurance Commissioner Doug Ommen, challenging his enforcement of SF 383. Wellmark argues that the law violates ERISA and imposes burdensome costs and administrative requirements on health plans. The insurer’s legal action follows a previous lawsuit filed by the Iowa Association […]
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November 13, 2025

EGWP marketplace medicaid Medicare

legislation

Oregon to Increase Payments to Medicaid MCOs

The Oregon Health Authority (OHA) announced that it will be increasing payments made to Medicaid Coordinated Care Organizations (CCOs) by an average of 10.2% in 2026. The increase is meant to help stabilize the Oregon Health Plan and support CCOs as they face increased financial strain due to higher utilization. OHA will also take targeted […]
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November 13, 2025

medicaid

AHIP Continues to Raise Awareness of Cost Impacts if Congress Fails to Extend ACA Health Care Tax Credits

AHIP highlighted multiple media reports this week noting that millions of Americans are getting “their first look at the sharp increases many will pay” if Congress fails to extend the enhanced premium tax credits that have made comprehensive, high-quality health care coverage affordable for 22 million Americans. TheAssociated Press reports that the expiring subsidies means premiums […]
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November 13, 2025

marketplace

survey results

AHIP/BCBSA Release New NSA Findings

On Oct. 24, AHIP and the Blue Cross Blue Shield Association (BCBSA) released findings from their 2024 No Surprises Act (NSA) survey, which revealed that nearly 40% of surprise billing disputes submitted to the federal Independent Dispute Resolution (IDR) process in 2024 were ineligible under the NSA. More than half of these ineligible disputes still […]
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November 13, 2025

EGWP marketplace medicaid Medicare

Solutions

The M3P Solution is Making Waves!

On Jan. 1, 2025, Express Scripts successfully launched the M3P solution to nearly all Medicare Health Plan clients – plus the entire EGWP line of business. By the end of Q4, an impressive 76,744 members had opted in. We’re proud to lead the industry in repayment rates, with 96% of members paying their billed amounts […]
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November 13, 2025

Medicare

perspectives

PCMA Highlights Recent Pro PBM Comments

PCMA recently highlighted several op-eds from policy analysts and economists who have spoken out on the value of PBMs. Satya Marar, visiting postgraduate fellow at the Mercatus Center at George Mason University, explained in a CounterPunch op-ed why PBMs are necessary to push back against the high list prices that drug companies alone set: “We’d […]
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September 9, 2025

EGWP marketplace medicaid Medicare

perspectives

New Report Finds Pharma-Backed Provision in Tax Law Likely to Cost Far More than Previously Estimated

The Campaign for Sustainable Drug Pricing (CSRxP) recently spotlighted a report by the The Wall Street Journal (WSJ) that a pharma-supported policy in the One Big Beautiful Bill Act is likely to cost seniors and taxpayers far more than previously estimated. The policy was based on a bill called “The Optimizing Research Progress Hope And […]
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September 9, 2025

EGWP marketplace medicaid Medicare