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Cigna Exceeds Expectations for Q2

The Cigna Group reported Q2 earnings that exceeded expectations, driven by growth in its services business. Total revenue in Q2 was $60.5 billion, up 24.6% year over year. It reported $1.5 billion in net income, up 6%.

Cigna is more isolated from Medicare pressures (small line being sold) and Medicaid pressures (no line). Evernorth’s services revenue rose nearly 30% year over year to $49.5 billion. Pharmacy service revenues grew more than 41% to $26.6 billion. In great measure this was due to the migration of Centene from CVS Caremark to ESI.

CEO David Cordani also committed to more aggressive defense of the value of its pharmacy benefit manager, ESI.

In related news, Cigna says its GLP-1 weight-loss program has enrolled two million.

Additional articles: https://www.healthcaredive.com/news/cigna-aggressive-pharmacy-benefit-manager-defense/722638/ and https://www.beckerspayer.com/payer/cigna-posts-1-5b-profit-in-q2-2.html  and https://www.fiercehealthcare.com/payers/evernorth-drives-double-digit-revenue-growth-cigna-q2 and https://www.beckerspayer.com/payer/cignas-glp-1-program-enrolls-2-million.html

(Some articles may require a subscription.)

#healthplans #cigna

https://www.modernhealthcare.com/insurance/cigna-earnings-call-evernorth-health-services-revenue-growth-medicare-medicaid

Humana Meets Expectations in Q2 But With Some Mixed News

Medicare Advantage (MA)-dominant Humana released its Q2 2024 results. It had $679 million in profit for the second quarter, down from $959 million a year ago. It had $29.5 billion in revenue for the quarter, compared to $26.7 billion in the second quarter of 2023. It affirmed its already conservative guidance.

It revealed that MA rates have complicated its financial performance and that it would shutter some plans in geographies and has reduced benefits in others. It expects to lose about 5% of its projected 2024 enrollment next year, or about a few hundred thousand. It will increase its enrollment this year by about 225,000. Only Humana and CVS Aetna performed well on the enrollment front recently.

Its medical loss ratio (MLR) was 89.5% in the quarter, compared to 86.8% in the second quarter of 2023. Humana blames the increased utilization on the recent 2024 rule regarding prior authorization. MA plans must now follow traditional Medicare program rules, including honoring physicians’ certification for inpatient admission that someone needs a hospital stay and will remain in the hospital for at least two midnights.

Humana says that the changes will allow it to get back to a target 3% MA margin over time. It is basically flat right now.

Additional articles: https://www.modernhealthcare.com/insurance/humana-medicare-advantage-costs-jim-rechtin and https://www.healthcaredive.com/news/humana-membership-losses-medicare-advantage-plan-cuts/722619/ and https://www.beckerspayer.com/payer/humana-2-midnight-rule-driving-up-inpatient-costs.html and https://www.beckerspayer.com/payer/humana-expects-medicare-advantage-membership-to-decline-by-a-few-hundred-thousand.html and https://www.healthcarefinancenews.com/news/humana-logs-679-million-q2-profit

(Some articles may require a subscription.)

#medicareadvantage #humana #rates #margins

https://www.fiercehealthcare.com/payers/humana-posts-679m-q2-profit-it-faces-continued-medicare-advantage-headwinds

Biden Administration Will Accelerate 2026 MA and Part D Rule Before Leaving Office

Interesting article in Modern Healthcare on plans of the Biden administration to accelerate the Medicare Advantage (MA) and Part D rule for 2026. The draft will be published in September, with the final rule sometime before President Biden leaves office. This could mean huge new policy changes for MA and Part D. Trump did something similar.

On one hand, Biden may want to leave office proposing some major reforms. On the other hand, the striking of the Chevron deference precedent could complicate enacting major changes.

The possible list of changes I see — they can’t do all of them, could they?:

• MA rate savings
• Further risk adjustment reform
• Overpayment reform
• Changes on drug pricing
• More prior authorization changes
• Fixing the federal court stay of agent-broker compensation
• More changes on supplemental benefits
• More health equity reforms
• More Special Needs Plan (SNP) changes and Medicare-Medicaid integration
• Star changes, including guardrail reforms, quality improvement hold harmless changes, and fixing TukeyGate

Separately, will he do more on antitrust and horizontal and vertical integration?

(Article may require a subscription.)

#election2024 #biden #healthcare #regulations #medicareadvantage #partd

https://www.modernhealthcare.com/policy/health-rules-2024-medicare-pay-prior-authorization

CMS Releases Part D Data For 2025; Sets Up Premium Stabilization Program

The Centers for Medicare & Medicaid Services (CMS) released preliminary technical Medicare Part D bid information for Contract Year 2025. The Part D base beneficiary premium is capped at 6% growth in 2025 due to a stabilization fund set up in the Inflation Reduction Act (IRA). This was because of all the transfers of costs to plans from the government and caps on out-of-pocket (OOP) costs. The anticipated enrollment weighted-average premiums were not released in part because CMS has proposed to create an additional voluntary premium stabilization demonstration program for standalone Part D (PDP) plans.

Many critics of the IRA reforms have suggested that premiums in 2025 could go up 50% to 100% (or more) due to the transfer of liabilities. The stabilization subsidy in the IRA only caps the base premium. Plans enhance benefits and will either have to cut enhancements, raise premiums, or both.

The proposed new premium stabilization program for PDPs features a number of caps and reductions to premiums and enhances risk corridor protections. It seems too good to be true – perhaps a sure sign that 2025 premium hikes filed were high and CMS is trying to find ways to mitigate impacts around election time so there is no October Surprise for the incumbent administration.

The potential premium hikes for Medicare enrollees are a huge problem for sure. CMS has some broad demonstration authority under statute, but the proposal does not seem to fit the normal parameters for a demonstration. CMS says it is testing “whether additional premium stabilization and revised risk corridors for stand-alone prescription drug plans (PDPs) increase the efficiency and economy of services. …” I am not convinced this is anything other than a massive additional subsidy to PDPs to deal with the unintended consequences of the IRA changes.

See my earlier blogs on this subject: https://www.healthcarelabyrinth.com/part-d-premium-woes-due-to-the-inflation-reduction-act/ and https://www.healthcarelabyrinth.com/will-democrats-be-victim-of-an-october-surprise-of-their-own-making/ .

#medicareadvantage #partd #pdp #medicare #ira

https://www.cms.gov/newsroom/fact-sheets/cms-releases-2025-medicare-part-d-bid-information-and-announces-premium-stabilization-demonstration