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Featured Story   Premise-Crossover Merger: Inside the $2B Push for a New Employer Health Model Who is coming together? Premise Health and Crossover Health are merging into a single company focused on scaling primary care for large employers. Premise's annual revenue is about $1.6 billion, and the combined company is expected to approach $2 billion, said Premise CEO Stu Clark. Why are they joining forces? Clark described the deal as a convergence of two companies with the same thesis: advanced primary care is the lever to disrupt U.S. healthcare. Both companies define advanced primary care as an integrated bundle of primary care, behavioral health, pharmacy services and care navigation. What problem will they tackle? Employers are turning to advanced primary care because traditional health plans can't control costs or improve access. The new company will be paid directly by employers on a fixed-fee basis, not using a fee-for-service model. Clark explained that higher utilization of its clinics will lead to better health outcomes, lower employer costs and greater value from the fixed fee. This model aligns incentives around prevention and engagement rather than volume-driven billing, he noted. Soundbite "Healthcare is now an earnings-per-share issue for American employers. It's one of the single biggest cost risks that they have in running their business. It's impacting their ability to deploy capital, and it's impacting their competitiveness," Clark remarked. —By Katie Adams  Sponsored   How Can AI Support Dental Service Organizations? Presented by Overjet There is a growing demand for advanced technology integration, such as AI tools for clinical decision support, for example, to improve patient care and DSO efficiency.  Get insights on how DSO can benefit with Overjet's AI applications. Click here to learn more. Is It Time to Change the Independent Dispute Resolution Process of the No Surprises Act? The background The No Surprises Act protects patients from unexpected bills and removes them from insurer-provider payment friction. The law requires insurers and providers to negotiate payment for 30 days, after which either side may pursue the Independent Dispute Resolution (IDR) process, where a neutral arbitrator selects one of the two proposed payment amounts.  While IDR was intended as a last-resort mechanism, some in the industry argue it is now being overused by providers — an issue highlighted by a recent lawsuit Anthem filed against Prime Healthcare. Anthem's lawsuit Anthem Blue Cross Life and Health Insurance Company, an Elevance affiliate, filed a lawsuit earlier in January against 11 Prime Healthcare facilities in California. Anthem accused these facilities of "knowingly flooding" the IDR process with more than 6,000 ineligible disputes and "extracting millions of dollars in wrongfully obtained awards."  Aside from this lawsuit, Elevance has cases against other companies in other states including in Georgia and Ohio. Soundbite "When this bill was passed, the federal government expected 17,000 of these cases to come through in any particular year," said Dr. Catherine Gaffigan, president of Elevance's health solutions business, in an interview. "Instead, what we have seen is millions of cases actually going through. And Elevance actually sees 17,000 of these a month. So clearly this has been exploited in ways that were never intended." Similar to 340B One industry expert — Michael Abrams of Numerof & Associates — compared the situation to the 340B Drug Pricing Program, which was designed to support safety-net providers but expanded rapidly over time. He argued that, like 340B, the IDR process was created with good intentions but risks being repurposed as a revenue-generating tool for hospitals rather than a limited backstop. – By Marissa Plescia Clinical Holds Cast Doubt on Approval Chances for Regenxbio Setback for a gene therapy A patient who received RGX-111, a Regenxbio gene therapy for the rare enzyme deficiency Hurler syndrome, has developed cancer, leading the FDA to place a clinical hold on the trial. The FDA also placed a clinical hold on studies for RGX-121, a separate Regenxbio gene therapy for Hunter syndrome. That's important because this gene therapy is currently under FDA review with a Feb. 8 target date for a regulatory decision. The cancer case is still under investigation. Why it matters Cancer is a known risk for genetic medicines delivered by adeno-associated viruses. Regenxbio has yet to receive the formal FDA letter with details about the clinical holds. But according to the company, the FDA said it placed a hold on both RGX-111 and RGX-121 due to similarities of the therapies and the patient populations as well as the shared risk between the studies. The FDA might end up turning down the Hunter syndrome gene therapy. The agency had already extended RGX-121's review after asking for longer-term data from trial participants. According to the Prescription Drug User Fee Act, a therapy can receive only one extension per review cycle. The unanswered question It's unlikely the FDA's questions about safety will be answered by Feb. 8. The agency has exercised "regulatory flexibility" in certain circumstances. Is there a workaround that can buy RGX-121 more time for its FDA review? Soundbite "We are surprised by FDA's decision to place our RGX-121 program on hold while the investigation of this single, inconclusive incident in RGX-111 continues," Regenxbio President and CEO Curran Simpson said in a prepared statement. "These are separate therapies, and the positive safety profile of RGX-121 in more than 30 patients treated, including those dosed nearly seven years ago, remains unchanged." — By Frank Vinluan Medication Affordability Depends on Total Price Transparency Navigating a chronic disease in the dark During one recent visit, a physician I hadn't yet seen recommended a CT scan for a recent Crohn's disease flare-up. "How much will that cost?" I asked a nurse, explaining that I'm on a high-deductible plan. No one could tell me. After about six hours of waiting and undergoing one other test for which I did not know the cost, I opted to go home instead. That particular day, the weight of an unknown expense on top of the long wait I had already experienced just wasn't worth it. A push for transparency and affordability Medication non-adherence, which is largely cost-related, contributes to billions in avoidable healthcare expenses each year. As a result, in 2026, we will see an intense push for an "affordability fix" for drugs with no generic equivalent. There will also be demands for increased transparency around four categories of prescription drug prices that consumers pay: the copay price set by insurance, which sometimes is higher than the cash-pay cost of the drug itself; the copay coupon price when a manufacturer coupon is used alongside commercial insurance; the cash price available to consumers without insurance and those who agree not to use insurance to purchase their prescription; and the direct-to-consumer price that consumers pay to drug manufacturers. Ending the pharmacy counter guessing game By integrating medication price information — including pharmacy copay coupons — into existing patient, provider, pharmacy and payer workflows, we can eliminate the fear that comes with a trip to the pharmacy. This approach ultimately will empower consumers with the information needed to make informed choices for their health. The impact will be improved medication access and better health outcomes for all. — By MedCity Influencer Miriam Paramore  Video   Video: Inside a New Recursion Drug Katie Couric lost her husband to colon cancer in 1998. Nearly 30 years later, colon cancer rates are rising sharply, especially among younger people, and scientists still don't fully understand why. Watch Couric chat with Najat Khan, CEO of Recursion Pharmaceuticals. Recursion is using AI to identify a promising compound that targets the underlying biology of the disease.

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Medication Affordability Depends on Total Price Transparency At a time when 98 million prescriptions are abandoned due to cost surprises, it's critical that all four categories of prescription drug prices are available so consumers can determine how to obtain needed medications at the lowest cost. 2026 Is the Year of the Doctor-Patient Relationship When paired with the expertise of health care providers, who serve as guides, partners in care, and healers, we have the critical elements in the formula for providing the patient with quality, personalized care, not merely on an episodic basis, but as the foundation of improved whole person care to take them through their life's journeys. Healthcare Moves: A Monthly Summary of Hires, Exits and Layoffs January has seen a slew of executive hires, promotions and layoffs across the healthcare industry. For instance, Aidoc, Suki and Particle Health named new executives. There were also layoffs at organizations including Takeda, Trinity Health and Horizon BCBS New Jersey.

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