Cigna Arm To Offer Humira Biosimilar At $0 Cost-Share

Finally, we are making some advances on biosimilar adoption.  For awhile, pharmacy benefits managers (PBMs) were teaming up with brand drug makers to stop the uptake of biosimilars through rebate arrangements.  That still happens, but PBMs are seeing the light. Evernorth’s Accredo Specialty Pharmacy will make a Humira biosimilar available to patients with no cost-share. Evernorth is partnering to produce the biosimilar. The biosimilar price is about 85% lower than that of the brand.

#biosimilars #drugpricing #brandrugmakers #cigna #evernorth


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Humana Bounced Back But Has Challenges

Humana’s Q1 2024 investor call was better than its Q4 one.  It reported better results, including a slightly improved medical loss ratio for its large Medicare Advantage (MA) business. Costs seem to be coming down but the delay in claims due to the cyberattack could cause a re-evaluation. Humana projects flat margins in 2024 and long-term margins to decline to a floor of 3%, which is noticeably down. It will cut $700 million in response in 2024. It pulled its 2025 projections for now.

It continued to note that the 2025 rate hike will mean reductions in benefits and retreating in some geographies. 

Additional article: https://www.modernhealthcare.com/finance/humana-medicare-advantage-profit-2024 and https://www.healthcaredive.com/news/humana-withdraws-2025-earnings-outlook-q1-2024/714105/ and https://www.beckerspayer.com/payer/humana-reported-741-million-in-net-income-in-the-first-quarter-of-2024.html and https://www.beckerspayer.com/payer/humana-plans-to-leave-some-medicare-advantage-markets-in-2025.html

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#humana #medicareadvantage


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FTC Votes To Ban Most Non-Competes

The Federal Trade Commission (FTC) bans most non-competes.  The final rule would ban such agreements for anyone that is not both a senior executive (in a “policy-making position”) and earning more than $151,164 annually.  These positions represent less than 0.75% of the workforce. The FTC does not have cognizance over non-profits. 

The rule is expected to be challenged in court, but seems to be a reasonable proposal.  Non-competes are used extensively in healthcare, even for doctors who do not meet the policy-making provision. This impacts up to 40% of doctors.

A non-compete would remain for senior positions, which does not seem unreasonable. Surprisingly, provider lobbies are against a ban, largely because they are now influenced by private equity owners, who seek to freeze out doctors from taking other jobs. Many entities promise to sue.

Additional articles: https://www.fiercehealthcare.com/regulatory/ftc-votes-3-2-issue-final-rule-banning-noncompetes and https://www.modernhealthcare.com/providers/ftc-noncompete-ban-agreement-lina-khan and https://www.healthcaredive.com/news/ftc-noncompete-ban-healthcare-doctor-effects/713846/

(Some articles may require a subscription.)

#ftc #noncompetes #healthcare


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United Did Pay Ransom In Cyberattack

United HealthGroup confirmed that personal health information (PHI) and personally identifiable information (PII) was exposed in the attack and “could cover a substantial proportion of people in America.” It also confirmed a ransom was paid. It will take awhile to get to what was exposed and who was impacted. Experts have data which points to the payment of a $22 million ransom by United.  United confirms that while some systems are functioning near normal, others are not yet up and will be restored over time.

In additional news, the United CEO will appear before a House subcommittee on May 1: https://www.reuters.com/business/healthcare-pharmaceuticals/unitedhealth-ceo-testify-before-us-house-panel-cyberattack-tech-unit-2024-04-19/ .

Additional article: https://www.modernhealthcare.com/cybersecurity/change-healthcare-update-unitedhealth-ransom

(Some articles may require a subscription.)

#united #changehealthcare #cyberattacks


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Optum Appears To Be Laying Off Employees Over Cyberattack

Given the fallout from the Change Healthcare cyberattack, Optum appears to be laying off hundreds if not thousands of employees.  United HealthGroup has not commented on the matter at this point. I have heard that some of the laid off employees are even within the Change Healthcare unit, which could be impacting the return to normal business operations for some plans and providers. If this is true, that is outrageous.

#changehealthcare #optum #cyberattacks


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Elevance Health Reports Positive Q1 News

Elevance Health reported overall good numbers for Q1 2024.  While membership has dropped in Medicare Advantage (MA) and Medicaid, margins were up and it reported little fallout on the Medicare medical expense or Change cyberattack front. Due to the MA rate cut, Elevance will balance business expansion with margin. On the call, the CEO also discussed the need to excel at Star measurement in MA.  It also continues to build its Carelon services unit.

Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-sees-double-digit-profit-growth-q1-posting-22b-earnings and https://www.modernhealthcare.com/insurance/elevance-health-medicaid-medicare-advantage-earnings

(Some articles may require a subscription.)

#elevancehealth #medicareadvantage


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Many Healthcare Bankruptcies Linked To PE Firms

I often talk about the pernicious impact that private equity firms have on healthcare.  Where the firms are successful, they tend to drive up costs in the system by buying provider groups, including owning emergency room providers, and pushing for huge payouts in No Surprises Act (NSA) arbitrations.  They also own hospitals where they cut costs due to high debt. Quality of course suffers and patient care takes a back seat. Such firms also force providers to practice at high-cost hospital places of service (the same is true for hospitals who are independent but are buying up doc groups).

But the other pernicious impact is on shoddy investments and the churn and fallout that occurs.  PE firms tend to saddle the entities they buy with debt.  What’s more, some of the investments are questionable and speculative.  A new report says that more than a fifth of the healthcare companies that filed for bankruptcy last year were owned by private equity firms. This is double the year prior.  And Moody’s Investor Services says there will be more PR-firm bankruptcies down the road. KKR and H.I.G Capital are repeat offenders with bankruptcies.  

Congress is investigating the far-reaching impacts PE firms have on healthcare. The Federal Trade Commission is looking too. They both should. I am all in favor of a private market in healthcare, but it should be accountable.

(Some articles may require a subscription.)

Additional articles:https://www.modernhealthcare.com/finance/private-equity-healthcare-2023-bankruptcy-envision-genesiscare-no-surprises-act and https://www.healthcaredive.com/news/private-equity-stakeholder-project-healthcare-bankruptcy/713297/

#privateequityfirms #healthcare #hospitals #providers


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Affiliate Of BlackCat Reportedly Published PHI From Change Cyberattack

While the main operator of BlackCat ransomware appears to have kept a rumored $22 million ransom paid by United HealthGroup, an affiliate published data from the Change Healthcare cyberattack after United did not pay an additional ransom.  The affiliate controlled the captured PHI and data.

#changehealthcare #cyberattacks


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Some Big Insurers May Lose Medicaid Contracts In Florida

Humana, Centene, and Elevance Health were the three big plans to win Florida Medicaid awards moving forward along with a number of local plans. But UnitedHealthcare, Aetna, Molina Healthcare, and AmeriHealth Caritas Florida were not given awards. Many states are seeking to cultivate local plans. Appeals will likely follow from the three big plans not selected.

Additional article here: https://www.fiercehealthcare.com/payers/unitedhealth-cvs-molina-big-losers-florida-medicaid-contract-awards

#medicaid #fl #managedcare #healthplans


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Physician Pay Increases, But Hurt By Inflation

A survey of physicians shows that pay increased by about 3% in 2023, but it was offset by high inflation.

#physicians #providers


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