CVS Health beats the Street with $2.9B in Q1 profit
fiercehealthcare - CVS Health beat the Street on both earnings and revenue in Q1, posting $2.9 billion in profit for the quarter.
AI Summary: CVS Health reported a $2.9 billion Q1 profit, driven by improved performance at Aetna and stronger-than-expected renewals, prompting an upward outlook. Executives point to insurance results and retail stability as drivers — insurance math quietly covering for a retail world that still loves convenience.
WakeMed Health's plans to join Atrium Health face swift pushback from NC officials
fiercehealthcare - A combination unveiled May 1 would bring WakeMed Health $2 billion in promised investment from the major nonprofit system. State officials voiced concerns about the impact of such consolidation and the value of those commitments, delaying a planned go-ahe…
AI Summary: Atrium Health’s plan to fold WakeMed into its system — backed by a roughly $2 billion investment plan — is running into immediate resistance from North Carolina officials. State leaders and local stakeholders have raised concerns about consolidation, competition and community impact, threatening regulatory scrutiny that could delay or reshape the deal. Expect tense negotiations, press statements and a few dramatic headlines.
Centene raises 2026 guidance with strong Q1 revenue, earnings results
fiercehealthcare - Centene kicked off the first quarter with better-than-expected revenue and adjusted earnings results, signaling a recovery from a rough 2025 as the insurer makes progress in managing medical costs.
AI Summary: Centene lifted its 2026 outlook after reporting robust first-quarter revenue and results, signaling confidence in managed care performance and enrollment trends. The company cited favorable operational metrics and market dynamics that supported the guidance bump, reassuring investors even as broader industry headwinds remain in play.
Chiesi signs $1.9B deal to acquire KalVista and its approved drug
Kyle LaHucik / endpoints - Chiesi is buying commercial biotech KalVista Pharmaceuticals for about $1.9 billion in an extension of the industry's vigorous spring shopping spree. The Italian pharma will pay $27 per share {$KALV} in cash to buy the ...
AI Summary: Chiesi Group agreed to buy KalVista for $1.9 billion to secure an approved therapy and expand its rare-disease footprint. The deal transfers marketed assets and R&D capacity, positioning Chiesi to scale rare-disease revenues and invest in next-wave therapeutics — essentially a big check for a bigger strategic play.
Avalyn Pharma Takes a Breath to Raise $300M in IPO Cash for Lung Drug Trials
Frank Vinluan / medcitynews - Avalayn Pharma found strong investor interest in its inhalable drugs in development for two types of pulmonary fibrosis, enabling the company to upsize its IPO. Data from two mid-stage studies are expected in 2027. The post Avalyn Pharma Takes a Breath to…
AI Summary: Avalyn Pharma has substantially increased its IPO, targeting roughly $300 million to bankroll late-stage trials of its respiratory drug candidate. The move reflects strong investor enthusiasm for lung‑disease therapeutics and gives the company a bigger war chest to advance programs previously dependent on venture capital and partnerships.
Cigna exits ACA exchanges despite dramatic profit growth in Q1
Rebecca Pifer Parduhn / healthcaredive - The insurer plans to say goodbye to the ACA exchanges after this year, and is exploring a potential sale of its controversial claims review subsidiary. Both businesses were more trouble than they were worth, executives said.
AI Summary: Cigna announced it will withdraw from Affordable Care Act individual exchanges even after reporting robust first-quarter earnings. The insurer cites strategic and operational reasons for exiting markets where risk and costs bite, a move likely to reduce competition in some states and could leave consumers with fewer plan choices or higher premiums.
FTC moves to shut down health insurance fraud scheme
Jakob Emerson / beckershospitalreview - A federal court has temporarily halted a Florida-based operation that the Federal Trade Commission alleges collected more than $91 million by deceiving consumers into purchasing fake health insurance coverage. The FTC filed its complaint April 7 in the U.…
AI Summary: The Federal Trade Commission filed suit seeking to halt a telemarketing operation accused of selling bogus PPO insurance plans. The action alleges deceptive practices that harmed consumers and triggered enforcement to freeze assets and shut down the scheme, demonstrating regulators still have a pulse when fraudsters find creative ways to sell imaginary “coverage.”
CMS, FDA announce new program to speed up Medicare coverage of breakthrough medical devices
fiercehealthcare - The Trump administration unveiled a new program to speed up Medicare coverage for breakthrough devices, touting that the new pathway cuts red tape for medical device companies to gain reimbursement. CMS said it will pause the existing TCET pathway.
AI Summary: CMS and the Food and Drug Administration launched a coordinated program to accelerate Medicare coverage for breakthrough medical devices, aiming to shorten the gap between regulatory approval and patient access. The initiative aligns agency review processes, defines eligibility, and seeks faster coverage decisions while maintaining safety and evidentiary standards.
- New imaging and monitoring devices promise faster, remote patient care. (3)
- On scene: agencies align to speed device approvals and coverage. (6)
New imaging and monitoring devices promise faster, remote patient care.
On scene: agencies align to speed device approvals and coverage.
Flagging first-quarter volumes dragged CHS’ earnings
Sydney Halleman / healthcaredive - Executives said consumer fears and aggressive denials from payers fueled declining volumes in the quarter, which led CHS to a $58 million loss. Still, the hospital operator said it expects volumes to pick up in the back half of the year.
AI Summary: Community Health Systems reported first-quarter earnings pressured by a steep drop in patient volumes, blaming a surge in payer preauthorization denials for the decline. Executives say the volume shortfall materially weighed on revenue and margins, underscoring how administrative friction between providers and payers can quickly translate into financial pain for hospital operators.
- CHS Q1: earnings hit by volume drops, blame on payers (4)
- Hospitals fight denials: startups, RCM shifts and C-suite focus (4)
- Medicare AI prior authorization pilot causing care delays (3)
- Payers move to standardize prior auth; Congress weighs in (4)
- All Other Stories
CHS Q1: earnings hit by volume drops, blame on payers
Hospitals fight denials: startups, RCM shifts and C-suite focus
Medicare AI prior authorization pilot causing care delays
Payers move to standardize prior auth; Congress weighs in
All Other Stories
FDA approves 1st 2-drug HIV treatment
Ella Jeffries / beckershospitalreview - The FDA has approved Merck’s once-daily, two-drug regimen for adults with virologically suppressed HIV-1. The treatment combines 100 mg doravirine and 0.25 mg islatravir and is indicated for patients with no history of virologic treatment failure and no k…
AI Summary: The FDA has approved Merck’s once‑daily two‑drug antiretroviral regimen, marking a notable market entrant poised to compete with established single‑pill therapies. Regulators cleared the novel combination on efficacy and safety data, setting up potential shifts in prescribing, pricing and competition — and giving Gilead something new to grumble about.
CMS delays Part D GLP-1 model amid skepticism from insurers
fiercehealthcare - The Trump administration is delaying a voluntary model that aimed to expand access to GLP-1s in Part D after pushback from insurers.
AI Summary: Federal regulators have paused a Medicare Part D pilot to expand coverage for GLP‑1 weight‑loss drugs amid payer skepticism and implementation concerns. The delay reflects worries about cost, program design and insurer buy‑in, forcing policymakers to revisit the model while patients and providers wait for clarity on whether Medicare will shoulder these high‑price therapies.
- CMS pauses Medicare GLP‑1 BALANCE pilot amid insurer pushback (4)
- Researchers chase GLP‑1 benefits, from gene therapy to Alzheimer’s (6)
- Telehealth and clinics scale GLP‑1 access, delivery and monitoring (3)
- All Other Stories
CMS pauses Medicare GLP‑1 BALANCE pilot amid insurer pushback
Researchers chase GLP‑1 benefits, from gene therapy to Alzheimer’s
Telehealth and clinics scale GLP‑1 access, delivery and monitoring
All Other Stories
340B drug discounts are drifting from patients to profit, and reform is now on the table
medicalxpress - The 340B Drug Pricing Program must be reformed to better patient health and disincentivize institutional profit-seeking behaviors, says the American College of Physicians (ACP). In a new policy, "Reforming 340B to Promote Program Integrity and Better Serv…
AI Summary: The 340B drug-discount program is under renewed scrutiny after analyses and advocacy groups argue discounts intended to help patients are instead boosting institutional margins. Hospitals, provider groups and the AHA are contesting HRSA proposals and court rulings, sparking policy debates and potential regulatory fixes to curb markups and steer savings back to vulnerable patients.
CMS to require states to audit Medicaid providers
Kristin Kuchno / beckershospitalreview - CMS Administrator Mehmet Oz, MD, said his administration will require all states to audit healthcare providers to address alleged Medicaid fraud, Politico reported April 21. Dr. Oz unveiled the plan at Politico’s Health Care Summit. Beginning this week, C…
AI Summary: CMS is requiring states to audit Medicaid providers as part of a new oversight initiative aimed at tightening program integrity and provider revalidation. The policy has sparked high‑level calls for nationwide reviews and a proposed 50‑state audit effort, signaling heightened federal scrutiny and potential changes to enrollment, billing and provider eligibility processes.
UnitedHealth Group boosts 2026 outlook as it posts Q1 earnings, revenue beat
fiercehealthcare - UnitedHealth Group is boosting its 2026 outlook after seeing some payoff to its efforts to control medical costs.
AI Summary: UnitedHealth reported stronger‑than‑expected first‑quarter results and upgraded its 2026 profit outlook, citing operational momentum and pricing moves that buoyed investor confidence. Coverage also captures contrasting takes on quarterly performance and the insurer’s ongoing strategy to reclaim margin, signaling a company shifting from defense to offense in a softening healthcare market.
- Earnings beat: UnitedHealth posts Q1 strength, raises 2026 outlook (3)
- Margin playbook: member cuts, buybacks, and broker pressures (3)
- Optum tech and exec pay: AI bets and compensation scrutiny (4)
- All Other Stories
Earnings beat: UnitedHealth posts Q1 strength, raises 2026 outlook
Margin playbook: member cuts, buybacks, and broker pressures
Optum tech and exec pay: AI bets and compensation scrutiny
All Other Stories
Eli Lilly Buys Startup CrossBridge Bio to Bring a More Powerful Strike to Tumors
Frank Vinluan / medcitynews - Eli Lilly is paying up to $300 million for CrossBridge Bio, a startup developing antibody drug conjugates that deliver two drug payloads to cancers. Beyond potentially better efficacy, CrossBio’s dual approach could also fight drug resistance. The post El…
AI Summary: Eli Lilly agreed to acquire CrossBridge Bio for up to $300 million, adding small‑molecule oncology assets to its pipeline. The deal accelerates Lilly’s tumor‑targeting strategy, reflects Big Pharma’s preference for buying nimble biotech innovation, and highlights ongoing consolidation trends that determine where promising oncology programs ultimately end up.
FDA approves Travere's Filspari as first drug for the kidney disease called FSGS
Nicole DeFeudis / endpoints - The FDA expanded the label for Filspari on Monday to add another kidney condition. The drug is now the first therapy approved in the US for focal segmental glomerulosclerosis (FSGS). The pill may be taken ...
AI Summary: The FDA approved Filspari for focal segmental glomerulosclerosis (FSGS), delivering the first specifically authorized treatment for this rare kidney disease. The approval provides a targeted therapeutic option for patients and marks a commercial milestone for Travere, raising hopes for better outcomes while spotlighting questions about access, pricing, and long‑term real‑world effectiveness.
Mount Sinai, Anthem reach 3-year agreement
Elizabeth Casolo / beckershospitalreview - Anthem Blue Cross Blue Shield in New York and New York City-based Mount Sinai Health System have established a three-year agreement, both organizations confirmed to Becker’s. The agreement includes hospitals, physicians and other providers. Mount Sinai sa…
AI Summary: Mount Sinai and Anthem reached a three‑year contract restoring in‑network coverage after negotiations, ending a period of uncertainty for patients and clinicians. The deal averts immediate network disruption and signals both sides' willingness to settle—proof that combat can end in compromise when hospitals and insurers remember patients actually use the services.
Baylor Scott & White Health Plan to exit Medicaid, individual markets; cut 321 jobs
Jakob Emerson / beckershospitalreview - Baylor Scott & White Health Plan said April 14 it will exit the Texas Medicaid managed care market and discontinue its individual marketplace plans, affecting roughly 225,000 members and eliminating 321 jobs statewide, according to the Dallas Morning News…
AI Summary: Baylor Scott & White announced it will leave Medicaid individual markets, a move that will shed hundreds of jobs and reshape coverage options for affected enrollees. The decision highlights ongoing financial pressures in public‑program participation and raises practical concerns about access continuity for people reliant on those plans.
New Bill Seeks to Lower Out-of-Pocket Drug Costs
Marissa Plescia / medcitynews - Rep. Greg Murphy introduced a bill that would require out-of-pocket prescription drug spending to count toward patients’ deductibles and out-of-pocket maximums regardless of where the drugs are purchased.The post New Bill Seeks to Lower Out-of-Pocket Drug…
AI Summary: Lawmakers introduced legislation to reduce out‑of‑pocket drug costs by allowing patients' direct drug purchases to count toward their insurance deductibles. The proposal aims to ease financial strain for people buying costly medications out‑of‑pocket, but would require insurers and pharmacy systems to change longstanding accounting and benefits practices.
Insmed shelves Brinsupri in skin disease after mid-stage flop
Elizabeth Cairns / endpoints - Insmed has given up on Brinsupri in the painful skin disorder hidradenitis suppurativa (HS) after a mid-stage trial failure. The company had ditched the pill in sinus inflammation at the end of last year. The ...
AI Summary: Insmed announced it will halt development of Brinsupri for a dermatologic indication following disappointing mid‑stage trial results. Company commentary stressed the skin setback does not negate Brinsupri’s potential in pulmonary indications, but investors and clinicians will understandably ask for clearer signs of life before buying the comeback story.