CVS Health To Settle PBM Lawsuit With FTC
CVS Health’s Caremark has become the second of the Big 3 pharmacy benefit managers (PBMs) to reach a settlement with the Federal Trade Commission (FTC) over insulin pricing. A court document filed Monday indicates the parties have requested that the matter be withdrawn “for the purpose of considering a proposed consent agreement.”
No details on the settlement were made public, but the concessions likely mirror the far-reaching elements agreed to earlier by Cigna’s Express Scripts PBM. United’s OptumRx PBM will undoubtedly have to settle too.
Additional articles: https://www.fiercehealthcare.com/payers/cvs-caremark-ftc-reach-settlement-insulin-pricing-case and https://www.healthcaredive.com/news/cvs-caremark-ftc-proposed-settlement-insulin-lawsuit/815581/
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#ftc #cvshealth #pbms #insulin #drugpricing
https://www.modernhealthcare.com/politics-regulation/mh-cvs-health-ftc-insulin-rebate-lawsuit/
Trump Administration Launches ASPIRE Model
The Centers for Medicare and Medicaid Services (CMS) announced a new model called ASPIRE. It will promote wraparound services for high-risk Medicaid and Children’s Health Insurance Plan enrollees through a payment demonstration. CMS will provide a handful of states with funding to improve care for children and young adults with complex behavioral and physical healthcare needs. CMS will distribute $125 million to state Medicaid agencies.
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#medicaid #schip #cms
https://www.modernhealthcare.com/politics-regulation/mh-cms-aspire-medicaid-pay-model-children
Highmark Reports 2025 Loss
Highmark Health reported climbing revenues across its Allegheny Health Network and Highmark Health Plans business lines in 2025, but the system had a net loss of $175 million. Highmark Health Plans reported a $608 million operating loss in 2025, compared with a $166 million loss the previous year.
Highmark also said there is an increase in Exchange members failing to pay their first premium payments, as well as a shift toward lower-cost Bronze plans.
Additional articles: https://www.modernhealthcare.com/insurance/mh-highmark-health-2025-earnings-utilization-medicaid/ and https://www.beckerspayer.com/financial/highmark-health-posts-674m-operating-loss-in-2025/
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#highmark #healthplans #margins
KFF Issue Briefers On Exchange Practices And BALANCE Model
Healthcare policy group KFF published two Issue Briefers today. The first is on statistics related to claims denials and appeals in the Exchanges. The second details the new BALANCE model, which brings GLP-1s to Medicare and Medicaid for obesity.
Additional article: https://www.kff.org/patient-consumer-protections/claims-denials-and-appeals-in-aca-marketplace-plans-in-2024/
#kff #balance #weightlossdrugs #glp1s #exchanges #claimsdenials
— Marc S. Ryan
