Drug Tariffs’ Impact
A new study from Fitch says that health plans will not see immediate impact from tariffs on drugs. Providers will bear the brunt upfront and pay higher costs in operations. But over time, providers will pass through the costs to insurers through increased rates.
In other news, a dozen states with Democratic attorneys general have filed suit over President Donald Trump’s use of the International Economic Emergency Powers Act (IEEPA) to enact new tariffs. The states argue they have a role due to the fact the tariffs could significantly increase costs for hospitals, manufacturers, and other stakeholders.
Additional article: https://insidehealthpolicy.com/daily-news/citing-health-costs-democratic-states-sue-trump-over-tariffs
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#tariffs #drugpricing #healthplans #providers
Vendors Strike Deal With GLP-1 Drug Companies
More and more weight-loss vendors are striking deals with GLP-1 drug makers, signaling the ability for compounders to create copycats is over now that shortages have been addressed. Hims & Hers is partnering with Novo Nordisk. The costs ($499) appear to be higher per month than the compounded versions but half or less the list prices of the drugs.
In other news, a new study says that Medicare costs would increase by $47.7 billion over 10 years if weight-loss drugs were covered under Medicare Part D for obesity alone. The Biden administration proposed it, but the Trump administration abandoned it.
Additional article: https://www.beckershospitalreview.com/glp-1s/medicare-part-d-coverage-of-glp-1s-could-raise-costs-by-48b/
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#weightlossdrugs #glp1s #drugpricing #medicare #partd
https://www.modernhealthcare.com/digital-health/hims-hers-novo-nordisk-glp1
Regulatory Input Provided By Healthcare
The Trump administration asked for stakeholder input related to its efforts to reduce regulations. Providers and health plans weighed in. Hospitals want a relaxation for the conditions of participation rules in Medicare and quality reporting. They also want streamlining of price transparency and payment model pilots to be voluntary. Some want the nursing home staffing rule formally expunged.
Health plans want a more balanced surprise billing rule and the scrapping of certain quality and performance reporting requirements.
(Article may require a subscription.)
#regulations #trump #healthcare
https://www.modernhealthcare.com/politics-policy/healthcare-regulations-cuts-cms
Elevance Restricts Medicare Advantage Marketing
Days after Elevance Health announced its optimism about Medicare Advantage (MA), the health plan said it will stop marketing most products under the program. Online marketing platforms will end this year and agents and brokers will have to submit paper applications for enrollees located in 22 states.
The insurer will continue marketing Dual Eligible Special Needs Plans (D-SNPs) in Florida only.
(Article may require a subscription.)
#elevancehealth #marketing #medicareadvantage
https://www.modernhealthcare.com/insurance/elevance-health-medicare-advantage-marketing-cuts
Most Blues Lost Money In 2024
Most Blue Cross and Blue Shield companies lost money last year, much of it related to rising Medicaid and Medicare costs. The vast majority of 31 Blues companies reported weaker operating margins. Operating margin fell 3.2 percentage points from a 0.3% gain in 2023 to a 2.9% loss in 2024. Eight Blues companies reported positive operating margins.
National players, even Blues, reported margin growth largely because profits from pharmacy benefits managers and service entities made money while insurance arms lost.
Overall, insurance lines throughout the country have had a cumulative negative margin of 1.2% from 2019 to 2024.
(Article may require a subscription.)
#healthplans #blues #margins
https://www.modernhealthcare.com/finance/blue-cross-blue-shield-medicaid-medicare
Medicaid Cuts Could Focus On Provider Taxes
A good article mapping out the issue of provider taxes in Medicaid. While GOP leaders say coverage won’t be cut, conservatives are demanding reductions to fund tax cuts, including in Medicaid. And many have become enamored with provider tax reforms.
The Trump administration recently submitted a rule on provider taxes (not yet published). Budget hawks in Congress want provider tax reforms, including a phasedown, to limit growth of the program in the future.
In other news, a prominent GOP leader in the House says Trump does not want coverage cuts and does not want the budget reconciliation bill to look like a healthcare bill.
Additional articles: https://thehill.com/homenews/house/5270013-gop-rep-jason-smith-trump-agenda-bill/
(Some articles may require a subscription.)
#medicaid #budgetreconciliation #coverage #providers
https://www.modernhealthcare.com/politics-policy/provider-taxes-congress-medicaid
— Marc S. Ryan
