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Healthcare Segments’ Top Priorities

A good article in Fierce Healthcare on the priorities of the various healthcare segments for 2025. Here are the highlights and there will be some battles between the parties.

Hospitals – extending Exchange premium subsidy enhancements, further health plan prior authorization (PA) and utilization management limits, fighting coverage reductions, and maintaining the 340b program substantially as is.

Plans – relief on Medicare Advantage (MA), and PBM reform (most health plans support except those with sister company PBMs).

Providers – a Medicare rate fix, reducing administrative burden, and workforce reform.

Also on the agenda is extending telehealth flexibilities and the hospital-at-home program.

#healthcare #healthplans #hospitals #providers #medicare #exchanges #medicaid

https://www.fiercehealthcare.com/regulatory/healthcare-lobbying-2025-here-are-top-policy-issues-hospitals-payers-docs-and-tech

Humana Continues Digging Out Of Its Financial Troubles

Medicare Advantage (MA)-dominant Humana told investors today that it was prioritizing efficiency as it continues to dig out from financial woes due to the MA rate and regulatory landscape. Due to uncertainty, including on rates, it is not yet able to give guidance going into 2026 but affirmed its guidance for the current year. Humana is also suing the Centers for Medicare and Medicaid Services (CMS) over its 2025 Star ratings, accusing the agency of gross regulatory violations and incompetence in administering the quality bonus program.

Humana posted a $693 million loss in Q4, an increase from a Q3 loss of $541 million. The company also halved its profits for the full year 2024 compared to 2023, posting $1.2 billion. Humana earned $2.5 billion in profit for 2023.

Humana expects to lose up to 550,000 MA members this year. It lost 445,000 during the recent open enrollment. Medicaid struggled as well from a cost and enrollment standpoint. In MA, Humana has lost a great number of high-revenue and usually highly profitable Dual Eligible Special Needs Plan (D-SNP) members. Overall medical loss ratio (MLR) was 91.9% in Q4.

Overall, the financial performance was better than expected and investors seem to think Humana is turning a corner financially. Humana appears to be shedding unprofitable products and enrollment around the country to improve margins. It is also expanding in Medicaid, which could boost its attractiveness in SNPs in the future.

Additional articles: https://www.modernhealthcare.com/finance/humana-medicare-advantage-investment-2025 and https://www.modernhealthcare.com/insurance/humana-medicare-earnings-outlook and https://www.healthcaredive.com/news/humanas-2024-profit-halved-medicare-advantage-losses/739761/ and https://www.beckerspayer.com/payer/humanas-no-1-medicare-advantage-priority-5-notes.html and https://www.beckerspayer.com/payer/humana-posts-693m-loss-in-q4.html

(Some articles may require a subscription.)

#humana #medicareadvantage #medicaid #margins

https://www.fiercehealthcare.com/payers/humana-posts-693m-loss-q4-it-continues-weather-elevated-utilization

Trump May Impose Tariffs On Drugs, But Calls Pricing Unfair And Wants Change

In an exclusive Super Bowl interview on Fox News, President Donald Trump seemingly endorsed tariffs on drugs but said in the end drug costs would come down. Many are worried that tariffs on drugs and other medical devices will further drive up healthcare costs. But Trump seemed to signal he intends to try to end the fundamental unfairness of drug prices in America compared with other developed countries.

Trump used the example of Ozempic costing $88 a month in the U.K., while it is $1,200 a month in America. Trump’s rough prices are entirely accurate and represents what he said was roughly ten times more in America. Trump said the U.S. has been too nice on the issue.

In a recent blog, I predicted that the populist Trump would come around on the issue of drug pricing and may press for real reform. See the blog here: https://www.healthcarelabyrinth.com/2027-drug-negotiations-off-and-running/ .

#trump #branddrugmakers #drugpricing #glp1s #weightlossdrugs

https://www.foxnews.com/video/6368624897112