December 11, 2023

Cigna-Humana Merger Off — For Now

The Cigna-Humana merger is reportedly off as the entities could not arrive at financial terms. This leaves Cigna with two big decisions: (1) What smaller deals will they enter into? and (2) Will they sell their Medicare Advantage (MA) business? While MA is a smaller portfolio than many big plans have, if it can improve its Star scores and make additional investments, it could still be lucrative for Cigna. On the other hand, Cigna may be investing most of its efforts in its non-margin-limiting Evernorth services subsidiary. Additional articles: https://www.modernhealthcare.com/mergers-acquisitions/cigna-humana-merger-deal-scrapped-stock-buyback and https://www.healthcaredive.com/news/cigna-humana-deal-falls-through-wall-street-journal/702091/ and https://thehill.com/policy/healthcare/4353008-cigna-ends-plans-to-merge-with-humana-report/

(Some articles may require a subscription.)

#healthplans #mergers #acquisitions #cigna #humana

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Bill Would Reform PBMs And Introduce Site-Neutral Payments in Medicare

I reported on this last week, but another good article describing a large House bill that would bring some transparency to PBMs and start site-neutral policies for Medicare Part B drugs and administration. As well, an additional article that lays out the arguments for and against site-neutral payments. I, of course, think the advocates are right. The issues raised by hospitals do not outweigh the huge difference in costs in the system as well as increased cost-sharing that folks pay. Additional article: https://www.healthcaredive.com/news/aha-fah-oppose-site-neutral-payments-drugs-congress-bill/701980/

#pbms #siteneutral #pricetransparency

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States Say They Are Working Toward Fixing Redetermination Mess

States are indicating they are working toward fixing some of the problems seen during the Medicaid redetermination process. Some reports of states doing some good things to outreach and re-enroll those cut off via procedural terminations. Many of the disenrolled being added back, but the sheer number of initial disenrollments is a huge concern and means the uninsured rate will increase.

(Some articles may require a subscription.)

#medicaid #redterminations

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Health Affairs Forefront Blog Series on Integrated Care Programs

The latest installment in a Health Affairs Forefront Blog series discusses integrated care programs. Of importance, it makes several recommendations for policymakers at the state and federal levels. The authors mention better state contracting provisions, aligned enrollment, and opportunities for states to breakout D-SNP contracts to have a free-standing D-SNP contract.

(Article may require subscription.)

#snps #dualeligibles #medicareadvantage

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— Marc S. Ryan

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