October 1, 2026

Overall, MA enrollment is expected to drop to 34 million people next year, down about 2 million people amid the market turmoil, according to insurer projections.

The companies that create these AI billing technologies are pushing back on this accusation, insisting their AI tools are getting providers what they are owed under the existing rules dictating reimbursement for care between payers and providers.

The four largest PBMs that were making up 75% of the national market in 2024 are UnitedHealth Group's OptumRx (23%), Express Scripts, a Cigna subsidiary, (23%), CVS Health's Caremark (18%) and Prime Therapeutics, which is jointly owned by multiple Blues plans, (11%). The report also examined industry vertical integration and found that payers vertically integrated with PBMs covered 69% of people across both commercial plans and Medicare Part D nationally in 2024. These findings highlight whether proposed or consummated mergers among PBMs and between insurers and PBMs should raise antitrust concerns.

Waltz Health partnered with Fresenius Kabi to expand its direct-to-employer program, offering transparent pricing for three biosimilars interchangeable with Humira, Stelara, and Actemra across rheumatology, dermatology, and gastroenterology. The program uses a flat-fee model that bypasses traditional wholesaler and rebate-based PBM contracts, aiming to reduce medication costs and improve patient access.

Robert Hunter has held numerous roles at UnitedHealthcare over the years, most recently serving as the CEO of government programs. Before that, he had a brief stint as CEO of Medicare and retirement at the insurer, which followed a year-long appointment as president of Medicare. Now, Hunter’s efforts will be focused on UnitedHealthcare’s goal of streamlining and modernizing patients’ digital experience with the insurer.