Federal policy changes, accelerating healthcare costs and shifting business priorities dominate the headlines for Fierce Health Payer's most-read stories of 2025.
Since President Donald Trump retook the White House in January, the policy landscape has shifted tremendously, with the summer's One Big Beautiful Bill Act set to reshape the Medicaid program across the country. The Centers for Medicare & Medicaid Services (CMS) has also unveiled multiple new payment models and program changes that will have ripple effects into the future.
Beyond policy and politics, rising healthcare costs are pushing employers and plan sponsors to rethink traditional models and having massive impacts on the business performances of major insurance companies. The ongoing challenges faced inside the industry were a major news thread throughout 2025.
The fallout from the massive cyberattack on Change Healthcare and contract and coverage disputes between payers and providers also make the list this year.
Here are the 15 most-read stories from Fierce Health Payer this year. This list is based on 12 months of page views, and is compiled in descending order.
15. Optum Rx to overhaul pharmacy reimbursement models
Pharmacy benefit managers have been under pressure to improve transparency and rethink traditional models as drug prices and costs continue to rise. UnitedHealth Group's Optum Rx took the proactive step in early 2025 to shift to a cost-based model that it says align more effectively with pricing shifts made by drug manufacturers. The change is set to particularly benefit community and independent pharmacies, per Optum. The PBM said it expects to have the model implemented fully by January 2028.
14. CMS may soon propose Medicaid provider tax regulation
The debate around the One Big Beautiful Bill Act (OBBBA) included multiple changes to health policy. Within that policy discussion, a proposed rule made its way to the Office of Management and Budget in April that appeared poised to shift financing around provider taxes in Medicaid. That change was ultimately shifted to the massive tax law, which barred new taxes and began to phase down existing ones. The new approach drew ire from the provider community, which warned it could stretch Medicaid budgets.
13. UnitedHealth Group offers buyouts to eligible employees: reports
2025 was a complicated year for UnitedHealth Group, which, as the largest healthcare company in the world, makes multiple appearances in our top 15 list. Early in the year, buzz on social media and layoff forums indicated that the industry giant was set to offer a severance package, with some 30,000 employees eligible for the buyout. The company's benefits operations unit was one of the divisions that was offered the severance package, according to media reports.
12. Medical orgs press Anthem to pull back out-of-network care policy
As healthcare costs continue to accelerate, more payer-provider contracting and coverage disputes have come to the surface. In October, Elevance Health's Anthem issued a provider notice that said it would charge a fee to in-network hospitals or outpatient facilities that use out-of-network providers, with the insurer saying the step was taken in response to escalating dispute resolution claims under the No Surprises Act. Providers have pushed back on the policy and urged Anthem to rescind it.
11. Congress clears hurdles for reconciliation with Medicaid cuts on the table
The lengthy back-and-forth over what eventually became the OBBBA sucked much of the air out of the room on the policy front from spring to late summer in 2025. Central to the debate was the Medicaid program, which was a key target for spending cuts and congressional Republicans looked to ax billions in federal funding. Ultimately, the bill cuts hundreds of billions in funding to the program over the next decade, alongside instituting work requirements nationally.
10. Optum Rx commits to passing through 100% of drug rebates, Witty says
As part of UnitedHealth Group's fourth-quarter 2024 earnings call, then-CEO Andrew Witty said the company would commit to passing through 100% of manufacturer rebates to the client. A shift in that direction was well underway, with Witty saying that, as of January, 98% of Optum's rebates were already passed through, while 2% remained as traditional rebates per the client's preference. He said the move "takes away the excuse of who is really setting the price" for drugs.
9. CVS terminates ACO REACH contracts, sells MSSP business to Wellvana
Much like UnitedHealth, CVS Health also faced major financial headwinds throughout 2025 and spent much of the year looking to cut costs and manage spend. Within that effort, the company chose to shut down its ACO REACH business, impacting 183 employees, and sell off its Medicare Shared Savings Program unit to value-based care enablement company Wellvana. The company said these moves were part of routine reviews of its business portfolio and that it remains committed to value-based care.
8. Aetna eases up on controversial MA inpatient payment policy
In another payer-provider contract dispute gone public, providers slammed CVS' Aetna for a proposed change that would impact how urgent and emergent inpatient claims were coded. The policy was set to kick in Nov. 15 and would have established a "level of severity inpatient payment" model for reimbursements. Under pressure, the insurer bumped the start date back to Jan. 1 and said inpatient stays of five or more midnights would no longer be subject to the severity review.
Medicare Advantage (MA) was a key source of mounting healthcare costs for insurers, forcing multiple companies to rethink their geographic footprints and plan designs to manage profitability. For industry leader UnitedHealthcare, that meant retreating from several underperforming regions in a move that would impact 600,000 people enrolled in its MA plans. Tim Noel, CEO of UnitedHealthcare, said on parent company UnitedHealth Group's second-quarter earnings call that the cost pressures were being felt beyond MA, too, including in the commercial space.
6. Will Trump's tax bill cut Medicare by $490B? Not exactly
The process to finalize the OBBBA was complicated, and the bill was changed and modified significantly several times. In May, the Congressional Budget Office issued an analysis that found the legislation, as it was written at the time, could trigger billions in cuts to Medicare in addition to planned cuts to Medicaid. Fierce Healthcare spoke with multiple experts who threw cold water on this analysis, saying Congress rarely elects not to waive key mechanisms under the Statutory Pay-As-You-Go Act of 2010.
5. Inside the evolving playbook for employee wellbeing
As employers navigate rising medical costs, they remain committed to key well-being and wellness efforts, as these offer critical tools for employee recruitment and retention. However, the strategy is shifting toward greater integration and targeted engagement to ensure workers are using the programs that will most benefit them. For this conversation on Fierce Healthcare's "Podnosis" podcast, I sat down with Jim Winkler, chief strategy officer at the Business Group on Health, to discuss how employers are adapting to the current environment.
4. Rising costs push employers to rethink benefits strategies: WTW
Analysts at WTW released the results of their annual survey into employers' benefit strategies, which found that rising costs were posing a major hurdle in offering extensive packages. Nearly half (44%) of those surveyed said they faced challenges in delivering on benefits strategies as costs increases, and 44% said that costs also made it harder deliver around wellness programs. Given this environment, the survey found employers are looking for their vendors to generate greater value.
3. CMS rescinds Medicaid's health-related social needs guidance
In March, the Trump administration rolled back Medicaid guidance around state Section 1115 waivers deployed to address health-related social needs. The notices, released in 2023 and 2024, gave details on opportunities that state programs could take to address social factors. The CMS said that after rolling back the guidance it would instead review applications on a rolling basis to determine whether they were allowed under federal requirements. The rollback was one of the early signs of the new White House's approach to the social determinants of health.
2. UnitedHealth estimates 190M people impacted by Change Healthcare cyberattack
The massive cyberattack on UnitedHealth Group subsidiary Change Healthcare was one of the dominant headlines of 2024, and, in early 2025, the company released an updated estimate that some 190 million Americans were impacted by the hack. UHG said in a statement to Fierce Healthcare at the time that it was unaware of anyone's data being misused as a result of the breach. An estimate submitted in 2024 to the federal government had suggested that 100 million individuals had been affected.
1. Justice Department hits Aetna, Humana, Elevance Health with Medicare Advantage kickback complaint
In May, the Trump administration filed suit against three major payers—Aetna, Humana and Elevance Health—as well as three broker organizations, alleging that kickbacks were paid in an effort to boost enrollment in the insurers' MA plans. The Department of Justice alleged that between 2016 and 2021, the insurers paid "hundreds of millions" in kickbacks to the brokers included in lawsuit. The brokers and payers all said they intended to vigorously defend themselves in the case.