Centene Earnings Guidance Released For 2025
Centene released its earnings guidance for 2025 at its investor day. Centene says revenue will be between $166.5 billion and $169.5 billion. It says utilization will continue to be elevated and its medical loss ratio (MLR) will be between 88.4% and 89%.
Centene reaffirmed that it expects to bring in between $143.5 billion and $144.5 billion in premium and service revenue for 2024. Its MLR will be between 88.3% and 88.5% for this year.
Centene expects to lose $250 million on Medicare Advantage (MA) this year but intends to break even by 2027. It also lost 20% of its MA enrollment during the 2025 enrollment season that just concluded.
Centene will gain $200 million in additional MA Star Ratings bonus payments in 2026 after the Centers for Medicare and Medicaid Services (CMS) revised its ratings.
Additional articles: https://www.modernhealthcare.com/insurance/centene-medicare-advantage-ratings-investor-sarah-london and https://www.beckerspayer.com/policy-updates/centenes-predictions-for-trump-administration-policy-3-things-to-know.html
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#centene #medicareadvantage #medicaid #managedcare
https://www.fiercehealthcare.com/payers/centene-expects-earn-least-1665b-revenue-2025
Site Neutral Payment Policy Details Vague
Sens. Bill Cassidy, R-LA, and Maggie Hassan, D-NH, continue to withhold details on the extent of their site neutral payment proposal. Cassidy did signal that their bill would not be as expansive as MedPAC, the congressional policy arms, proposal. In November, the lawmakers suggested the bill would remove the exception from the 2015 site-neutral law to require site-neutral payments apply to all hospital-owned sites of care that aren’t on the main campus. Currently, this applies only to new facilities. The bill also would set rates for the most common services based on where they’re most typically performed. The senators will protect rural and safety net hospitals. My view is we should go all-in on site neutral payment reform.
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#siteneutral #hospitals #medicare
House GOP Launches Investigation Of CVS Health
The House GOP is investigating whether pharmacy benefit manager (PBM) CVS Caremark violated antitrust laws by threatening independent pharmacies to keep them from using money-saving tools outside the PBM’s network.
#cvshealth #pbms #drugpricing #pharmacies
Scaled-Down Interoperability Rule Finalized
Healthcare regulators finalized a scaled-down version of a follow-up interoperability rule. The final regulation focuses on the Trusted Exchange Framework and Common Agreement, a governance framework for data exchange. The certification proposed in the draft was struck.
#interoperability #healthcare
Ro Enters Agreement With Eli Lilly On Zepbound
Direct-to-consumer health and wellness company Ro entered into an agreement via Eli Lilly’s self-pay pharmacy channel to lower the costs of GLP-1 weight-loss drug Zepbound. Single dose vials will be offered at $399 per month for 2.5 milligram doses and $549 per month for 5 milligram doses.
#glp1s #weightlossdrugs #drugpricing #branddrugmakers
CBO Releases Cost-Cutting Menu
In its report released today titled “Options for Reducing the Deficit: 2025 to 2034,” the Congressional Budget Office (CBO) released its wide-ranging menu of cost-cutting possibilities, including those in the healthcare arena. This could be part of a blueprint the Trump administration and a GOP Congress uses to help pay for extension of the 2017 Trump tax cuts. Other proposals for various conservative healthcare groups, including the Heritage Foundation and the Paragon Health Institute, will also be relied on.
#healthcare #trump #budget #medicare #medicareadvantage
https://www.cbo.gov/system/files/2024-12/60557-budget-options.pdf
— Marc S. Ryan
