Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.

Healthcare Brew

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Health Insurance

Cassie McGrath

Healthcare Brew delivers the latest news and trends in healthcare.

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Another day, another example of CVS not beating the vertical integration 

Earlier this month, Aetna enacted a new policy for its commercial medical plans mandating drugs be supplied by third-party specialty pharmacies under CVS, the health plan’s parent company, and shipped directly to suppliers. Previously, these facilities have purchased drugs for patients independently and billed for them under a health plan’s medical benefit.

The policy, effective as of July 1, is a sign of vertical integration and puts infusion centers in a difficult financial position that could eventually lead to their closure, experts told Healthcare Brew.

Now, five drugs treating conditions like multiple sclerosis, uncontrolled asthma, and rheumatoid arthritis for Aetna patients are covered under a pharmacy benefit, meaning they will be delivered from a CVS specialty pharmacy.

An easy way to understand the challenges for infusion centers is comparing it to if customers brought their own steak to a restaurant and asked a chef to cook it, Robert Gelfand, founder and president of New York treatment facility American Infusion Centers, told us.

“Part of the business model we operate on is being able to buy the medication and bill for it,” Joshua Katz, director of Massachusetts-based medical clinic the Elliot Lewis Center, said. “If the specialty pharmacy buys the drug and bills for it, that eliminates that source of revenue for us. It’s hard to be profitable.”

Gelfand said his center runs on “relatively modest profits” and policies where a company yields higher returns on a few drugs (which can turn into more and more over time) like this are “insidious.”

 found clinics could lose out on nearly $2,000 per month if their drugs are delivered via an insurance company (aka “bagging”) rather than when they directly purchase the drugs. The study showed on average a $300+ per month rise in out-of-pocket payments for patients under the bagging method as well.

Right now, CVS is in the spotlight, but Gelfand is worried this kind of policy could spread to other drugs or payers. If it does, his business may no longer be able to sustain itself, he said, and may even be at risk of closure.

He may need to stop taking Aetna patients due to these financial challenges, Gelfand added.

Working with specialty pharmacies is also a “big administrative burden” on infusion centers, Katz said, as it requires phone calls, benefits verification, and shipment coordination. Without specialty pharmacies, the infusion centers can simply order drugs on their own.

If there’s a problem with drug temperatures or a drug is contaminated during shipment, or if a delivery is sent to the wrong address, the infusion center isn’t allowed to substitute a medication with another drug they have on hand, Elliott Warren, executive director of advocacy group Infusion Providers Alliance, said.

Considering that many patients at infusion centers have serious illnesses, Warren said he’s worried quality of care will suffer.

“It’s another example of a big payer and insurance company standing between a physician and their patient, all for, frankly, their own self-interest,” he said.

The Infusion Providers Alliance was informed about the policy before it went into effect and 

 on June 12 to Aetna outlining the group’s concerns, highlighting potential patient care, cost, legal, and supply chain issues.

When asked about the reasons behind the new rule, CVS spokesperson Phil Blando told us in an emailed statement the policy will allow the pharmacy chain “to better control the cost of the drugs and keep premiums more affordable, while still providing members with safe, convenient access” to certain drugs.

In recent years, CVS, UnitedHealth, and Cigna have 

 the healthcare industry. Essentially, these top three companies, which control 80% of the prescription medicine market, can set the cost of drugs while also operating the pharmacies that dispense them.

The infusion center leaders said this new Aetna policy is another practice in which CVS is pushing business into its own specialty pharmacy arm through beneficiaries covered under its health plan.

“It’s a theoretical death knell for infusion centers,” Glefand said.

Aetna’s new specialty drug policy ‘insidious’ for infusion centers, one leader says

Infusion center leaders accuse CVS of trying to funnel business back into itself. 

illustrated headshot of caroline catherman, healthcare brew reporter

Caroline Catherman

HCBR-ICHRAs-audio embed

An individual coverage health reimbursement arrangement (ICHRA) is an atypical way to cover health costs with a bold pitch.

Instead of offering a traditional group plan, employers give workers money before tax to buy whatever insurance plan works for them on the individual market, paying more or less depending on what they need. Think health insurance à la carte.

The idea is to give workers more freedom and give employers more predictable healthcare costs.

“It gets [employers] out of a one-size-fits-all mentality of picking a plan or a set of plans for all employees,” Zachary Sherman, managing director at public healthcare-focused research and consulting firm Health Management Associates, told us.

The concept first soft-launched to employers with 50 or fewer workers in 2017 with qualified small employer health reimbursement arrangements (QSEHRAs). ICHRAs then stretched health reimbursement arrangements to employers of all sizes in 2020 after an executive order by President Donald Trump.

While there’s no comprehensive public enrollment data, employers reportedly offered ICHRAs to 200,000+ employees and their dependents in 2025, according to data from 15 ICHRA/QSEHRA service providers 

 trade and advocacy organization the HRA Council. Uptake hasn’t been explosive, but the data shows it’s risen 19% overall since 2020 and 34% among large employers (50+ employees).

“It felt like, if one big employer took a leap, others might follow. But we hadn’t reached that point,” JoAnn Volk, co-director of Georgetown University’s Center on Health Insurance Reforms, told us.

Now some experts say health reimbursement arrangements might be about to hit a new set of speed bumps, just as the race against group plans was getting interesting. 

“The whole premise of an HRA is based on having a robust, healthy individual market, and that’s no longer assured. It’s very much at risk,” Volk said.

Experts told us changes proposed in July’s One Big Beautiful Bill Act and June’s Marketplace Integrity and Affordability Final Rule might make it more expensive and difficult to sign up for individual coverage, potentially keeping ICHRAs from living up to the hype.

People with lower medical costs may decide individual insurance isn’t worth the hassle, Volk said.

“The people who will persevere are the ones who say ‘I need this coverage no matter what it costs me, and no matter how many hoops I have to jump through,’” Volk said.

If those who choose to keep their health insurance coverage are sicker and use their coverage more, payers may raise premiums or cut everyone’s benefits to compensate.

 from nonpartisan health policy research group KFF predicts the average out-of-pocket payment will rise 75% for people who use Healthcare.gov or state-based 

. Enrollment is currently at a record 24 million, though that number could drop by more than 11 million based on actuarial group Wakely’s analysis of an earlier version of July’s bill. Among the changes:

Automatic re-enrollment ends starting in plan year 2028.

The open enrollment window shortens by two weeks beginning in plan year 2027.

Stricter eligibility verification requirements for the premium tax credit will be effective in plan year 2028.

, which are set to expire at the end of the year.

The minimum percent ACA-regulated plans must contribute toward patients’ costs lowers beginning in plan year 2026 (aka more cost-sharing for patients).

For ICHRAs to work, “there needs to be a healthy, robust, and vibrant individual market of ACA plans. And so, any actions that move us away from that don’t further that goal,” Josh Schultz, strategic engagement manager of Softheon, a healthcare technology company that provides enrollment, billing, and payment solutions to health plans and government agencies, told us.

The final version of the One Big Beautiful Bill also removed an earlier provision that would have codified ICHRAs and given $100 monthly tax credits to participating small employers.

Volk specifically pointed to one clause buried in the June marketplace rule that lowers the share of patient costs an ACA-regulated plan must cover, effective 2026.

This matters for ICHRAs because it has long been law that large employers must contribute a minimum to their employees’ health reimbursement arrangements in order for coverage to be considered “affordable”—otherwise, they’re fined. That minimum is calculated for each employee using, in part, the cost of the lowest-cost standard silver-tier plan on the marketplace that year.

So if silver plans cover less, employers can contribute less, which shifts more of the financial burden of premiums and out-of-pocket costs to employees. The rule’s text argues this could increase ICHRA adoption, making large employers more willing to get on board because it would be cheaper for them.

Alan Silver, president of Centene’s ICHRA offering, said he views this model as “the future of employer-sponsored healthcare” in a statement to Healthcare Brew, echoing a similar remark by Centene CEO Sarah London in a February earnings call. As of March 31, Centene touts nearly 28 million managed care members, of which people in ICHRAs make up a small portion.

Louis DeStefano, SVP of growth at insurer Oscar Health—which, according to DeStefano, has just under 2 million members primarily in the individual exchange marketplace—said he hopes Oscar can become “one of the leaders” in the ICHRA market.

He argues ICHRA is attractive because of its ability to really individualize insurance—the insurer has plans specifically for people with diabetes, for instance.

DeStefano added it’s possible that Trump or Congress might eventually extend premium tax credits or take other actions to otherwise incentivize ICHRA growth.

“The administration remains supportive of ICHRAs as a means to efficiently strengthen the individual market and expand employee insurance choices for small businesses. President Trump made meaningful progress during his first term to expand ICHRAs, and we are committed to building off that progress,” White House spokesperson Kush Desai told us.

A hand reaching out to medical crosses on a store shelf, with all different price points.

How recent policy could impact ICHRAs

A recent marketplace integrity rule could halt ICHRA momentum.

It’s no secret that the healthcare industry is a 

 experiencing cybersecurity incidents each year.

 in 2024, there were major attacks at Anthem, CareFirst BlueCross BlueShield, and UCLA Health Systems about 10 years prior that had set the industry ablaze. The trend was a wake-up call for providers who were increasingly using electronic health records but perhaps didn’t incorporate enough protections to keep patient data safe online.

Cyberattacks aren’t just invasive for patients—they’re also very costly. 

 last year, in fact, that healthcare data breaches cost an average of $9.8 million per incident.

These attacks were a lesson for the entire industry in 2015, and experts spoke with Healthcare Brew about how the approach to cybersecurity shifted after.

“The only thing that really moves the needle in cybersecurity is a high-profile attack,” Mark Stockley, a cybersecurity expert, said.

 in February 2014 but wasn’t disclosed until about a year later when health plan Anthem announced a hacker had stolen personal information—including names, health identification numbers, dates of birth, social security numbers, addresses, telephone numbers, email addresses, and employment and income information—of 78.8 million former and current members.

The hack was reportedly found by a database administrator who noticed his credentials were being used without his permission, according to the California Department of Insurance. The company said in January 2015 the database was shut down immediately following the discovery, and staff changed their passwords. The company paid 

 through 2020 to settle lawsuits related to the incident.

Soon after in June 2014, CareFirst, a BlueCross BlueShield company, experienced a cyberattack that exposed “a single database” associated with the company’s website and online services. The company announced in May 2015 hackers had stolen personal information about 1.1 million members and business associates.

Also in May 2015, UCLA Health confirmed it had been hit by a cyberattack that was suspected as early as October 2014, tech news site 

. The attack impacted 4.5 million patients. Data like names, social security numbers and medical information had been stolen, and UCLA Health paid a $7.5 million settlement in March 2019 for not reporting the breach sooner under the HIPAA privacy rule.

None of these companies provided comments on the attacks.

Part of the problem in the Anthem attack, in particular, was that the company 

 personal information, Leeann Nicolo, incident response lead at cybersecurity insurance company Coalition, who also worked on recovery for the Anthem attack, said. Encryption includes changing data and information into code, so it’s harder for hackers to determine the meaning.

Back in 2015, encryption and multi-factor authentication (MFA) were not norms like they are today, she added. (Some companies still don’t have MFA requirements, as seen in the Change 

“The breaches were wake-up calls that exposed how vulnerable this data could be,” she said, adding she remembers thinking healthcare lagged behind other industries in being prepared for hacks.

Cyberattacks against the healthcare industry are on the rise. A 2025 data breach 

 found that the industry saw 1,710 security incidents between Nov. 1, 2023, and Oct. 31, 2024—an increase from 1,378 security incidents the year before.

Since 2015, Nicolo said budgets for threat detection as well as investments in security operation centers and endpoint detection and response tools have increased “significantly.”

A survey of 273 healthcare cybersecurity professionals by the 

Healthcare Information and Management Systems Society

 found that 52% of respondents said their organizations “would increase” IT budgets from 2024 to 2025.

Attacks led to the establishment of other norms like remote desktop protocol for people working outside the office and robust offline backups, which are secondary secure places for data to be stored in case of emergency. There’s also been a push to move cybersecurity from a smaller IT concern to a “strategic board-level risk,” Nicolo said.

“[Execs] started planning for it financially—they put people in positions where that was their only role,” she said.

There’s also more awareness today compared to 10 years ago around phishing attacks, where a user is tricked into providing personal information, Nicolo said. However, she said these attacks have become “more sophisticated,” employing methods like using token theft, or a tactic through which a bad actor obtains MFA information to access accounts.

Regulations—such as stricter enforcement and fines from HIPAA and the FDA as well as state privacy laws like the 2018 California Consumer Privacy Act—have also created more protections for healthcare data.

“There’s “more regulations with more teeth,” Nadya Bartol, managing director at consultancy BCG Platinion, said.

While the industry has learned some lessons, this remains a continuous cycle: New tech emerges as fast as it can to beat its competitors to market, but as a result, sacrifices cybersecurity along the way.

When the inevitable attack comes and sensitive data that wasn’t properly safeguarded is compromised, then new regulations are drafted and safety protocols are adopted, Bartol said.

“We need to learn to move fast and not break things,” Bartol said.

One area that needs more scrutiny, Nicolo said, is the use of third-party vendors, as some companies assume those groups have security covered. It’s important to vet suppliers, make sure they have proper security, staffing, and training, and that their systems are up to date, Nicolo said.

Additional regulations may be coming to the industry. A healthcare cybersecurity act was 

 in Congress in June that would require the federal Cybersecurity and Infrastructure Security Agency and Department of Health and Human Services to work together and study cyber risks to the healthcare industry.

Meanwhile, attacks continue to get more advanced.

“Maybe there is more of a business case for getting first to market responsibly because if you’re not responsible, you’re going to suffer consequences,” Bartol said.

Anthem Health Insurance facility on February 5, 2015 in Indianapolis, Indiana.

How Anthem, UCLA Health, and CareFirst cyberattacks taught the healthcare industry to boost protection in 2015 

Cybersecurity protections like encryption and multi-factor authentication have since become more common in healthcare. 

How cyberattacks taught the healthcare industry to boost protection in 2015 

51% of healthcare consumers now view their health plan as a “partner” in their care, rather than just a “payer” of medical bills. The HealthEdge® 

 explores what members want from their health plans—and how health plans can evolve to meet consumer expectations.

Here’s a peek at what consumers reported:

78% of respondents use or plan to use mobile health plan apps.

64% of respondents are open to trying AI-powered healthcare tools, but many are concerned about privacy and security.

42% of respondents list monthly premiums or out-of-pocket costs as reasons to stay or leave a health plan.

HealthEdge

Payer vs. partner: How health plans can create member-centric healthcare experiences

Amid regulatory uncertainties, high utilization, and changing marketplace rules, payers aren’t doing great right now.

 its prediction for its annual performance in May after Medicare Advantage utilization surpassed its highest expectations. Now, it’s Centene’s turn in the spotlight.

 Centene pulled its 2025 revenue guidance on July 1 after actuarial firm Wakely predicted fewer people would get Affordable Care Act (ACA) marketplace coverage than expected, and those who did would be sicker—and costlier.

Wakely’s analysis included 22 of Centene’s 29 marketplace states, making up about 72% of the company’s individual marketplace plan members. The company reported that as of March 31, it had 5.6 million marketplace members.

The company also shared that it saw a “step-up” in Medicaid costs, particularly in New York and Florida, where it’s a market leader.

Following this announcement, the company’s shares 

 nearly 40% from $56.65 to $33.78. The stock has since fallen further, dipping below $30 at time of publication amid policy changes in the past two weeks from the One Big Beautiful Bill Act, which could hurt profits in the future given that the majority of Centene’s business is government-sponsored healthcare.

“Current risks outweigh future opportunities,” Paige Meyer, an equity analyst for independent research group CFRA Research, wrote in a July 12 research note on Centene.

Centene declined to provide comment beyond its press release.

Centene said in its July 1 release it plans to refile its 2026 marketplace rates for some states, increasing them in order to reflect the higher member acuity.

But while Centene has a “meaningful path” to repricing its 2026 rates, it will also “be repricing at a time when the ACA exchange risk pools are potentially worsening, which could make the process more challenging,” JPMorgan analysts wrote in a July 2 research note.

The JPMorgan analysts pointed to several policy changes threatening the ACA marketplace risk pools.

For instance, on June 20, the federal government finalized the Marketplace Integrity and Affordability rule, which takes steps like “strengthening” income verification. On July 4, President Donald Trump signed a reconciliation bill that experts allege will make it 

 to enroll in the ACA marketplace due to factors like shorter open enrollment periods and the eventual end of automatic reenrollment.

 are set to expire at the end of the year, and the government hasn’t moved to extend them.

 these changes could raise the number of uninsured people by 16 million by 2034. Nearly 25 million people were uninsured in 2023, according to 

JPMorgan’s analysts added in a separate July 14 report that the Wakely analysis indicates the ACA marketplace member pool as a whole has “deteriorated” in 2025.

“This could be a pressure point for [managed care organizations],” they wrote.

Molina, a California insurer that specializes in Medicaid, Medicare, and ACA plans, 

 soon after Centene on July 7. The company reported 4.8 million Medicaid, 260,000 Medicare, and 662,000 ACA marketplace members as of March 31.

In this photo illustration, the Centene company logo is seen displayed on a smartphone screen.

What Centene’s crisis means for other managed care organizations 

Tumultuous policy and sick members are muddying revenue predictions.

Nicole Ortiz

We’re a little over halfway through 2025, and it’s safe to say this year has seen a lot of movement and 

So we decided to check in with some execs we spoke with at the beginning of the year about where they’re at with the goals they 

These interviews have been lightly edited for length and clarity.

Brian Evanko, president and COO, the Cigna Group

The first half of 2025 has proven that the US healthcare system remains highly dynamic, and we continue to innovate and evolve rapidly to meet the needs of our customers, clients, clinician partners, and all those we serve. We’ve accelerated our work to leverage data, advanced analytics, and emerging AI capabilities to improve our customers’ experiences as part of our “Commitment to Better” [initiative] launched earlier this year, and we just announced an AI-powered virtual assistant and a suite of other digital features to help Cigna Healthcare customers navigate their healthcare more easily. These are just examples of the actions we are taking to make healthcare simpler, more personalized, and more technologically enabled. We still have work to do, but I am proud of the progress we are making.

Chris McKee, SVP, chief strategy and business development officer, the University of Texas MD Anderson Cancer Center

We’ve made progress on many key priorities that allow us to continue to deliver exceptional patient care, to define the leading edge of cancer treatment and research, and to advance the development of new and improved clinical facilities. Notable examples include:

In May, we announced a transformational $150 million gift from Kinder Foundation to create Kinder Children’s Cancer Center, a joint venture of UT MD Anderson and Texas Children’s.

MD Anderson launched its Institute for Cell Therapy Discovery and Innovation in November 2024 to build upon longstanding expertise and to lead the world in advancing impactful cell therapies for patients in need.

Construction continues on our fifth research science building as well as multiple facilities in the Texas Medical Center and Greater Houston Area, and we continue planning for our future comprehensive cancer in Austin.

Heart ecg adjusted to create the appeal of an upwards chart

Execs share progress they’ve made toward their 2025 goals

While it’s been a busy year so far, leaders are still making major decisions for their healthcare organizations.

With pandemic-era Affordable Care Act (ACA) subsidies due to expire at the end of the year, health insurance alternatives could take advantage.

A June 11 report from global professional services firm Alvarez & Marsal (A&M) predicts that more beneficiaries might soon ditch insurance coverage for options like 

 plans or healthcare sharing ministries (

), which aren’t regulated like health insurance and aren’t required to comply with ACA protections like covering maternity care or pre-existing conditions.

Craig Savage, A&M managing director and health plans and managed care practice leader, told Healthcare Brew that A&M has recently worked with “one of the larger” HCSMs—which he declined to name—to help the ministry scale in anticipation of more enrollment.

“They are really gearing up for growth in membership,” he said. “The market dynamics, the environment in which we find ourselves, I think, is going to lend itself to those health sharing ministries.”

Health insurance policy changes proposed in President Trump’s “big beautiful bill” would 

 of people, potentially sending them in search of a cheaper health plan alternative, Savage explained.

 at the end of 2025, and neither the Trump administration nor Congress has yet moved to extend them. CVS Health’s Aetna is 

 the ACA marketplace, affecting about 1 million beneficiaries in 17 states—and more payers 

Republicans in Congress have also proposed 

 significantly or adding work requirements.

The Congressional Budget Office predicted on June 4 that the expiration of subsidies could cause 4.2 million people to lose health insurance coverage by 2034, and that further changes to Medicaid and marketplace rules could impact millions more.

Savage also thinks it’s possible the Trump administration may expand flexibilities in some way for alternatives like short-term, limited duration plans—like he did 

“I think they will show greater flexibility in the structure and the requirements of these short-term duration products. I don't know how that will manifest itself,” Savage said.

Right now, enrollment in insurance alternatives is relatively low compared with more traditional options: In 2023, about 305.2 million people had health insurance at some point, according to the US Census Bureau, compared to at least 1.5 million in HCSMs, per a 

 from Colorado’s state insurance regulator.

The most recent enrollment count for short-term plans comes from a 2020 Democratic Committee staff’s oversight investigation, which found there were about 3 million people enrolled during 2019 across nine companies.

Savage also said that payers are promoting a type of plan that became available in 2020: individual coverage health reimbursement arrangements (

), where employers give workers money to buy their own individual market plan through the ACA marketplace.

In contrast with short-term plans and HCSMs, these plans are governed by the Affordable Care Act and are required to provide minimum coverage for things like pregnancy and pre-existing conditions.

He pointed to Centene as an example. In a February call, the insurance company’s CEO Sarah London called ICHRA “the future of health insurance for working Americans.”

“I haven’t heard health plans…talk a lot about these short-term duration products as much as I’ve heard, you know, a Centene talk about ICHRA products,” he said.

Doctor and patient on the left and white house on the right