Healthcare Dive reports that Carl Icahn has gone public with this campaign to defeat the proposed merger of Cigna and Express Scripts.  The Wall Street Journal adds that

[Mr. Icahn] suggests that Cigna instead strike a multiyear partnership with a pharmacy-benefit manager—potentially Express Scripts—and buy back stock.

Cigna said in a statement Tuesday that Mr. Icahn appears to be making a financial bet against the transaction. His comments demonstrate a “lack of understanding of the dynamics of the health-care industry,” Cigna said.

Cigna’s shareholders of record on July 10 will vote on the transaction on August 24. The Express Scripts shareholders will vote on the same day. Both votes requires majority support for the merger agreements to close, assuming no federal government objection.

Health Payer Intelligence helpfully suggests some ways that health plans can adjust cost sharing in order to improve the health of people with chronic ailments. One size does not fit all.

The Centers for Medicare and Medicaid Services announced today that its giving Medicare Advantage and Part D plans significantly more latitude in managing prescription drug benefit costs. Specifically Medicare Advantage plans will be permitted to negotiate prices for drugs, typically injectables, that are covered under Part B and Medicare Advantage and Part D plans will be able to implement step therapy arrangements under which patients try out more cost effective drugs before using the more expensive substitute.

On the government reorganization front, Nextgov reports that

The government’s head of background investigations is fully in favor of moving his office, staff and workload under the Defense Department, a shift that is expected to become official under an impending presidential executive order.

Congress passed legislation last year requiring the National Background Investigations Bureau—part of the Office of Personnel Management—to transfer investigations of Defense personnel and contractors to that department. NBIB would retain only the civilian government portion, but that partial shift would ultimately be untenable, according to administration officials.

“The truth is that that split would have been debilitating, distracting and, frankly, counterproductive,” NBIB Director Charles Phalen said during an Aug. 7 Nextgov event on insider threats. “Good news is, after further review … the administration had determined that bifurcation is probably not a good idea.”