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Change Pharmacy Network Back On

While insurtechs overall have struggled, at least three – Alignment Healthcare, Devoted Health, and Clover Health – appear to be doing well.  Clover Health had an adjusted EBITDA loss of $19.1 million in the fourth quarter and a full-year loss of $44.7 million last year.  This is significantly better than in 2022. Its medical loss ratio (MLR) is projected to be just 81.2% for 2024. It expects adjusted EBITDA profit up to $20 million. Since it began, it, too, amassed a sizeable membership.

#clover #insurtechs

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Clover Health Readying For Positive Margin

While insurtechs overall have struggled, at least three – Alignment Healthcare, Devoted Health, and Clover Health – appear to be doing well.  Clover Health had an adjusted EBITDA loss of $19.1 million in the fourth quarter and a full-year loss of $44.7 million last year.  This is significantly better than in 2022. Its medical loss ratio (MLR) is projected to be just 81.2% for 2024. It expects adjusted EBITDA profit up to $20 million. Since it began, it, too, amassed a sizeable membership.

#clover #insurtechs

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UnitedHealth Group CEO Hears From Becerra And Providers

At an unprecedented meeting, UnitedHealth Group CEO Andrew Witty heard from both Health and Human Services (HHS) Secretary Xavier Becerra and providers at a government sponsored meeting. The plea was for United to take responsibility for the Change Healthcare cyber attack and give        additional financial support to providers.

In addition, HHS detailed more about what a $1.3 billion fund for cyber security would be used for.  About 2,000 hospitals will receive incentive funds to adopt new cyber security practices. Another $153 million would go for various government initiatives.

Additional article: https://www.fiercehealthcare.com/providers/becerra-stakeholders-its-time-take-accountability-cybersecurity

#changehealthcare #unitedhealthcare #cyberattacks

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Biden Releases His FFY 2025 Budget

The President announced his FFY 2025 budget even as all bills for the current FFY 2024 year have not been approved (including Health and Human Services spending).  Biden did sign into law the bill that funds some agencies for the current fiscal year, including a partial retreat on a major Medicare doc cut. Because of the split in Congress, most of his proposals are dead on arrival but serve as campaign differentiators against his GOP opponent, former President Donald Trump.

In the FFY 2025 budget, Biden funds the commitments he made at the State of the Union and more:

  • Expanding the Inflation Reduction Act’s Medicare drug price negotiations
  • A $2,000 cap on commercial retail drug cost-sharing
  • A commercial insulin cap of $35 per month
  • A Medicaid-like program for those in the coverage gap
  • Almost $1.5 billion in cyber-attack funding
  • $150 billion over 10 years for home and community care expansions
  • Tax increases on the wealthy to help stabilize Medicare
  • Expansion of eligibility in Medicaid and the children’s health program
  • Elimination of children’s health premiums
  • A fix of funding caps in Medicaid for territories
  • Making the temporary enhanced premium subsidies in the Exchanges permanent
  • Major liberalization to ensure biosimilar uptake

Additional articles: https://www.modernhealthcare.com/politics-policy/biden-budget-cybersecurity-insurance-subsidies and https://insidehealthpolicy.com/health-insider/admin-releases-budget-addresses-fallout-over-change-healthcare-attack and https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more

(Some articles require a subscription.)

#budget2025 #healthcare #healthcarereform

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Biden SOTU Address Fiery And With Major Expansion Requests

President Joe Biden gave a fiery campaign speech at the State of the Union Thursday.  He touched on policy changes he wants to see across government and society.  In the healthcare world, he asked for significant additions to what he thinks is his successful record:

  • Major expansion of Medicare drug price negotiations.  As opposed to the maximum of 60 drugs in the current law, Biden wants the ability to negotiate the prices of 500 drugs over the next decade.
  • Permanent expansion of enhanced premium subsidies in the Exchanges.
  • A special healthcare program for those in the coverage gap in the ten states that have not expanded Medicaid.
  • A $2,000 annual cap on drug cost-sharing in commercial products.
  • A $35 per month insulin cap in commercial products.
  • Extension of inflation-cap drug rebates to commercial products. 

Additional articles: https://www.fiercehealthcare.com/payers/biden-call-drug-negotiation-expansions-stronger-reproductive-care-access-sotu and https://insidehealthpolicy.com/daily-news/biden-advocates-expansion-drug-price-controls-aca-state-union and https://www.modernhealthcare.com/politics-policy/joe-biden-state-union-sotu-2024

(Some articles may require a subscription.)

#biden #sotu #healthcare #healthcarereform #aca #obamacare #exchanges #drugpricing #ira #coveragegap #insulin

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Almost 18 Million Initially Lost Medicaid Coverage During Redeterminations

The Kaiser Family Foundation reports that almost 18 million initially lost coverage during Medicaid redeterminations.  Some regained eligibility later.  Most lost coverage on procedural grounds.  Enrollment has dropped by about 10M so far in Medicaid nationwide.

#medicaid #redetermintations

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Walgreens Will Have Long Road To Recovery

Walgreens says that its road to financial recovery will be long – not a 12-month plan.  It is undertaking a strategic review of its business. It plans to cut $1 billion in expenses this year. 

Additional article: https://www.modernhealthcare.com/providers/walgreens-tim-wentworth-villagemd-shields-health-ownership

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#walgreens

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Cuban Recommends Radical Change In Drug World To Reduce Costs

I am a big fan of Mark Cuban and what he and his Cost Plus Drugs are doing to reform the drug price system.  So when he speaks, I listen.  At a White House round table, Cuban proposed that federal programs cut off all ties to traditional pharmacy benefits managers (PBMs) and embrace full transparency.  He has a direct-to-consumer firm and various transparent PBMs are all in on this idea.  

The White House liked the transparency idea but knows it is easier said than done and there are many barriers to unravel what we have now. I note that the transparency model emerging right now works well for generic drugs, but it will be harder and take more time for brand drugs, especially until we get prices lower and solve for the shadowy rebate system.

But Cuban’s transparency and frankness is where the drug world needs to go. Cuban and advocates for reform also noted that at least some of the shortages we are seeing now are caused by the traditional opaque pricing and delivery channels. Cost Plus Drugs will begin manufacturing generics, targeting some with major supply issues. Hopefully Cuban’s radical approach gets people to think differently. PBMs need to reform. Brand drug makers have to embrace lower prices while safeguarding innovation. Direct-to-consumer models are the way to go.

Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/biden-admin-urged-cut-ties-top-pbms-achieve-lower-drug-costs

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#drugpricing #cuban #costplusdrugs #pbms #healthcarereform

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FFY 2024 Spending Package Agreed To By Key Lawmakers

A bipartisan spending bill has been agreed to by key lawmakers and will need to be voted on in each House.  The package basically cuts in half the Medicare doc fix cut of 3.4%, pushes back scheduled disproportionate share hospital (DSH) payment cuts, and increases annual funding for community health centers. Accountable Care Organizations’ (ACOs) bonus program was also protected. Absent from the bill are major healthcare reforms. Docs are not very happy with the partial fix and no total overhaul of their rates.

Additional articles here: https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more and https://insidehealthpolicy.com/health-insider/lame-duck-battle-looms-health-wins-skinny-bill-expiring-december and https://insidehealthpolicy.com/daily-news/skinny-health-package-scales-back-doc-fix-adds-chc-funding and https://www.medpagetoday.com/practicemanagement/reimbursement/109008 and https://thehill.com/policy/healthcare/4507164-government-funding-bills-leave-out-phamacy-benefit-manager-industry-changes-as-white-house-mulls-reforms/

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#governmentshutdown #healthcare

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Medicare Advantage Will Remain Viable Over The Long Run

Good article in Modern Healthcare discussing the fact that, while there will be major bumps in the road, Medicare Advantage (MA) will remain viable and strong.  A great quote from Paul Ginsburg, senior fellow at the University of Southern California Schaeffer Center for Health Policy and Economics. “We’re not talking about any risk to the financial integrity of these companies at all. The Medicare Advantage business is very viable long-term because they’re providing something that more and more Medicare beneficiaries are deciding they want,” Ginsburg said. “Will it be as great for the next few years as it has been? Probably not. It’ll still be very good, though.”

This echoes what I said in a January 29, 2024 blog ( https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ ) as well as a February 9 Podcast ( https://www.healthcarelabyrinth.com/9-is-medicare-advantage-exploding-after-its-boom-or-simply-adjusting/ ).

As I say, the real victims of terrible policies from the Centers for Medicare and Medicaid Services (CMS), such as the prior authorization rule, will be fixed income seniors who will lose a great deal of benefits.  It is a shame.

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#medicareadvantage

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