April 1, 2024

New GLP-1 Survey Says Growth Is Explosive

A new survey from Virta Health backs up the bleak cost picture. It says that 43% of health plan leaders are predicting 100% or more growth in GLP-1s for weight loss and obesity in 2024. More than half say GLP-1s will be a top 3 drug in 2024 in terms of spending. One fifth say they will be their most expensive drug class this year. Executives believe the media is misrepresenting GLP-1s and that lifestyle programs should be tried first. At the same time, a Vitra Health-linked study comes to a different conclusion on what occurs after stopping GLP-1s.  It says those who stop taking GLP-1s can avoid negative effects on glycemia and body weight if they are properly engaged in their healthcare, including proper nutrition.

See my blog today on the subject: https://www.healthcarelabyrinth.com/whats-all-the-clamor-over-glp-1s-for-weight-loss/

#weightlossdrugs #drugpricing

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CMS Maintains Insufficient Rate Change In Medicare Advantage 2025 Final Notice

The final notice of Medicare Advantage (MA) 2025 rates does not substantially deviate from the earlier advanced notice.  Plans say that rates will drop with the ongoing phase-in of a new risk adjustment formula. The Centers for Medicare and Medicaid Services (CMS) argue that revenue will go up due to risk score trends. 

In Thursday’s blog, I will deep dive on the final notice.  Given the prior authorization changes as well as higher medical utilization, the rate cut will lead to a realignment and diminishment of MA benefits.

CMS press release and fact sheet: https://www.cms.gov/newsroom/press-releases/cms-finalizes-payment-updates-2025-medicare-advantage-and-medicare-part-d-programs and https://www.cms.gov/newsroom/fact-sheets/2025-medicare-advantage-and-part-d-rate-announcement

Additional articles: https://www.modernhealthcare.com/policy/medicare-advantage-rate-cut-cms-2025 and https://www.beckerspayer.com/policy-updates/cms-finalizes-2025-medicare-advantage-rates.html

(Some articles may require a subscription.)

#medicareadvantage #rates

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Fed Plan On AI And Health Equity

Federal health IT officials unveiled a strategic plan outlining priorities over the next five years.  The draft plan focuses on health equity and artificial intelligence.

Draft plan: https://www.healthit.gov/sites/default/files/page/2024-03/Draft_2024-2030_Federal_Health_IT_Strategic_%20Plan.pdf

#ai #interoperability #healthequity

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FTC Sues To Stop Hospital Acquisition On Antitrust Grounds

The Federal Trade Commission (FTC) is seeking a preliminary injunction to stop Novant Health from acquiring two Community Health Systems hospitals in North Carolina. The FTC argues that the deal would  “irreversibly consolidate the market for hospital services in the Eastern Lake Norman Area in the northern suburbs of Charlotte.” The FTC says it would stifle competition and increase prices because Novant would control 64% of the market. The move is part of the Biden administration’s increased antitrust scrutiny in healthcare.

Additional article: https://www.modernhealthcare.com/mergers-acquisitions/ftc-novant-health-chs-sale-north-carolina

(Some articles may require a subscription.)

#mergers #acquisitions #antitrust #hospitals

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Cybersecurity And Antitrust Front In Center In M And A Deals

While deals and activity continue, the Change healthcare cyberattack has put security on the top priority list for due diligence.  The Biden administration’s antitrust scrutiny is also top of mind for M and A.

(Article may require a subscription.)

#manda #mergers #acquisitions

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Digital Health Startups Short On Cash And Investors

Given tightening markets, digital health companies are short on cash and struggling to get investments or sizes they would like to see.  Investors are concerned about high-profile bankruptcies and adoption rates.

(Article may require a subscription.)


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Big Pharma And Related Parties Trying To Reinstate Dismissed Lawsuit On Medicare Drug Price Negotiations

The Pharmaceutical Research and Manufacturers of America (PhRMA), Global Colon Cancer Association (GCCA) and National Infusion Center Association (NICA) are seeking to reinstate their challenge to the Medicare drug price negotiations. They are repealing the dismissal. The lawsuit was tossed by a Texas federal court on various jurisdiction issues.

(Article may require a subscription.)

#ira #drugpricing #branddrugmakers

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CMS Issues Playbook Of Rules To Follow For Redeterminations

With disenrollments approaching 20 million due to the reintroduction of Medicaid redeterminations, the Centers for Medicare and Medicaid Services (CMS) is again laying out rules that states must follow during the process. It unveiled a detailed slide deck to states on the issues. The Kaiser Family Foundation reports that at least 19.156 million Medicaid enrollees have been disenrolled as of March 26, 2024, based on the most current data from all 50 states and the District of Columbia. 

Kaiser latest data here: https://www.kff.org/report-section/medicaid-enrollment-and-unwinding-tracker-overview/

(Some articles may require a subscription.)

#medicaid #redeterminations #cms

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Healthcare Is A Real Election Issue – Even If It Looks Like It Ranks Low

Good article in Forbes on why polls saying healthcare issues are now low on the priority issue are wrong.  Yes, as a discrete item they may rank low, but as the author notes healthcare is now mixed in with numerous other issues, including the economy.  This is consistent with other polls, especially from the Kaiser Family Foundation tracking poll, that shows voters are still very worried about healthcare affordability and their coverage.  I continue to say this as a real swing issue in a small number of states that will decide the presidential election.

#healthcare #election2024 #coverage

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— Marc S. Ryan

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