CVS Health / Aetna

Highmark taps Aetna exec to lead insurance business

Highmark has named Gustavo (Gus) Giraldo as president of its health insurance division, effective immediately. Mr. Giraldo most recently served as senior vice president of individual and family plans at Aetna, and he’s previously held executive leadership roles at Magellan Health and Cigna Healthcare. He succeeds Tom Doran, who is departing the organization to pursue […] The post Highmark taps Aetna exec to lead insurance business appeared first on Becker's Payer Issues | Payer News .

Aetna to cut Medicare Advantage broker commissions again

Aetna will stop paying broker commissions on certain Medicare Advantage plans beginning Sept. 15, the company confirmed to Becker’s. “Aetna routinely reviews and updates our distribution strategy, including the commissionable status of our plan offerings,” an Aetna spokesperson said. “As a result, we have made a business decision to change certain plans to non-commissionable starting […] The post Aetna to cut Medicare Advantage broker commissions again appeared first on Becker's Payer Issues...

Four health systems, including Ochsner and Denver Health, go live with Epic's real-time prior authorization checks

UnitedHealthcare, Network Health and Aetna are among the first group of health plans to go live with the API, while Ochsner Health, Froedtert ThedaCare Health, Denver Health and Summit Health are the four health systems now using the real-time prior auth checks.

CVS board member resigns, replaced by JPMorgan’s chief data officer

CVS Health has appointed JPMorgan Chase’s Chief Data and Analytics Officer, Teresa Heitsenrether, to its board of directors, effective Nov. 18. The company also announced the departure of board member Larry Robbins, effective Aug. 13. Mr. Robbins, founder and CEO of Glenview Capital Management, had served on CVS’ board since 2024. The post CVS board member resigns, replaced by JPMorgan’s chief data officer appeared first on Becker's Payer Issues | Payer News .

Aetna cuts Medicare Advantage commissions for 2027 sales

Medicare Advantage carriers continue to take a cautious approach to enrollment amid high costs.

A look at where Aetna is seeing value-based care success in Medicare Advantage

Aetna is seeing its value-based care efforts pay off in both preventive care metrics and cost savings, according to a new analysis from the company.

Oscar taps CVS exec as chief health officer

Lia Gass Rodriguez, MD, is joining Oscar Health as chief health officer. The company shared the update on LinkedIn Aug. 13. Dr. Rodriguez had worked at CVS Health as a leader for CVS Healthspire Payor Solutions and Aetna. Previously, she was a medical director for Houston-based Texas Children’s Hospital’s health plan, according to her LinkedIn […] The post Oscar taps CVS exec as chief health officer appeared first on Becker's Payer Issues | Payer News .

Medicaid Managed Care: The Big Five in Q2 2026

The “Big Five” have announced their results for the calendar quarter ending June 30. They are, of course, the five publicly-traded companies with the largest presence in the Medicaid managed care market, together accounting for about half of all Medicaid enrollees: Centene Corporation, CVS Health/Aetna, Elevance Health, Molina Healthcare, and UnitedHealth Group. The Medicaid market […]

CVS Caremark taps chief growth officer

CVS Health’s pharmacy benefit manager, CVS Caremark, is bringing on Keith Reynolds as chief growth officer. Chief Sales Officer Jim Fowler will transition into retirement, according to an Aug. 7 LinkedIn post from Mr. Reynolds. Mr. Reynolds had spent 25 years at CVS Health and Aetna previously, the post said. He most recently was COO […] The post CVS Caremark taps chief growth officer appeared first on Becker's Payer Issues | Payer News .

CVS earnings boosted by Aetna as Caremark membership slips

Net income soared and revenues increased across all segments for CVS Health.

District court rules AHA can file amicus brief in case challenging Aetna’s ‘level of severity’ policy

The U.S. District Court for the Eastern District of Pennsylvania Aug. 5 granted a motion for the AHA and the Hospital and Healthsystem Association of Pennsylvania to file an amicus brief submitted in June in support of Jefferson Health’s challenge to Aetna’s “level of severity” reimbursement policy. The policy is a reimbursement for “low severity” inpatient stays that Aetna said will be “comparable” to observation rates. Aetna moved to have Jefferson Health’s case decided in arbitration rathe...

CVS raises guidance as it posts nearly $3B in profit, $106B in revenue for Q2

CVS Health is raising its guidance for the year as it blew past Wall Street analysts' expectations in the second quarter.

CVS falls after preliminary 2027 guidance disappoints

The upbeat results signal that CVS Health is making progress on turning around its health insurance subsidiary Aetna.

CVS Health profit triples in Q2

CVS Health brought in nearly $3 billion in profit for the second quarter of 2026, up from $1 billion during the same period in 2025. Total revenue was $106.1 billion for the quarter, a 7.3% year-over-year increase. The company lifted its adjusted EPS guidance range from $7.30 to $7.50 to $7.90 to $8.10. Aetna Revenue […] The post CVS Health profit triples in Q2 appeared first on Becker's Payer Issues | Payer News .

Payers ranked by digital experience|2026

In 2026, Aetna offers the best digital experience among major insurers on both desktop and mobile, according to new research from Corporate Insight shared with Becker’s. Corporate Insight’s “2026 Commercial Health Plan Experience Benchmark,” published Aug. 5, evaluated 24 commercial payers across more than 240 desktop and mobile functions. The report identifies overall health plan […] The post Payers ranked by digital experience|2026 appeared first on Becker's Payer Issues | Payer News .

Oklahoma system out of network with Aetna

As of Aug. 1, non-emergency, scheduled elective services provided by Oklahoma-based Norman Regional Health System are no longer in network for Aetna members. The update affects commercial, Medicare Advantage and administrative-services-only plans, with Medicaid excluded. Norman Regional said negotiations had been ongoing “for months.” “Across the country, healthcare providers are experiencing rising costs related to […] The post Oklahoma system out of network with Aetna appeared first on Beck...

ELLSWORTH ASSOCIATES, LLP v. CVS HEALTH CORPORATION

Case 2:19-cv-02553-JMY Document 282 Filed 07/31/26 Page 1 of 39 IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA UNITED STATES OF AMERICA, ex rel. : ELLSWORTH ASSOCIATES, LLP, : : Plaintiff-Relator, : Civil Action : Original document

A look at CVS’ march toward a simpler patient experience

CVS Health Chief Medical Officer Amy Compton-Phillips, M.D., joins senior writer Paige Minemyer to unpack initiatives such as CVS Health 100 and discuss what the ideal patient experience might look like.

What's behind Aetna's investments to build provider trust

Addressing healthcare's biggest challenges will require payers and providers working together.

Aetna’s chief medical officer pushes back on the ‘AI bot war’

Artificial intelligence is now embedded across health insurance and care delivery operations, but Aetna’s chief medical officer says the industry still has a choice in what it does with the technology, even if early results aren’t encouraging. “AI opens the door to move at a speed and with a level of clinical engagement that’s really […] The post Aetna’s chief medical officer pushes back on the ‘AI bot war’ appeared first on Becker's Payer Issues | Payer News .

FTC, CVS Health agree to settle PBM insulin suit

The federal government in September 2024 sued the country’s three largest pharmacy benefit managers for allegedly inflating the list price of insulin drugs.

Advancing healthcare engagement among older adults

Watch Jeff Fernandez, Medicare President at Aetna, discuss strategies to improve healthcare engagement, access and outcomes for older adults.

CVS, Omnicare reach $440M settlement with Justice Department

CVS Health plans to sell its Omnicare pharmacy services subsidiary to GenieRx Holdings.

An Executive Conversation with Jeff Fernandez, Medicare President, Aetna

AETNA NETWORK SERVICES LLC v. POONIA

Case 2:26-cv-06623-ES-MAH Document 1-17 Filed 06/05/26 Page 1 of 74 PageID: 139 EXHIBIT Q Case 2:26-cv-06623-ES-MAH Document 1-17 Filed 06/05/26 Page 2 of 74 PageID: 140 Provider manual Resources, policies and procedures at your fingertips Aetna.com 1126773-01-02 (8/23) Case 2:26-cv-06623-ES-MAH Document Original document