February 6, 2024

Centene Reports Good Numbers, But Cautions On MA Rates

Centene reported good numbers to Wall Street today, with notable increases in its Exchange line of business. Medicaid enrollment dropped due to redeterminations.

But like Humana, Centene is cautioning that the Medicare Advantage (MA) 2025 rate announcement was inadequate and could lead to further benefit and other changes in its MA line. It also notes that other regulatory changes are impacting its MA investment.  Centene has already pared back benefits and geographies to bring its MA line to a better financial position.

Additional articles here: https://www.modernhealthcare.com/insurance/centene-medicare-advantage-rate-cut-2025-sarah-london and https://www.healthcaredive.com/news/centene-medicare-advantage-rate-drop-2023-earnings/706620/

Two other articles on the fallout from MA rates and regulatory changes here: https://www.modernhealthcare.com/insurance/medicare-advantage-rate-cut-2025-reimbursements-benefits-unitedhealth-humana and https://www.statnews.com/2024/02/05/cano-health-bankruptcy-medicare-advantage/

These articles underscore what I said in these blogs: https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ and https://www.healthcarelabyrinth.com/2025-rates-for-medicare-advantage-plans-look-tight/

(Some articles may require a subscription.)

#centene #medicareadvantage

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Another Big Week For Drug Policy

Much like last week, this week is very active on drug policy. Comments are due on President Biden’s proposal to “march-in” on drug patents.  Legislation on Congressional Budget Office (CBO) scoring will be looked at, including regarding Medicare drug pricing law impacts.  The CBO says it will update its last estimate on the impacts of Medicare drug pricing legislation this week, too.

(Article may require a subscription.)

#drugpricing #ira

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Good Kaiser Health News Article On Social Needs Funding In Medicaid

A very balanced and timely Kaiser Health News (KHN) article on 19 states that have expanded Medicaid to cover a number of social needs, including housing.  There have been mixed results.  There is a good discussion on the pros and cons of this expansion.  One good question raised is will the scope creep hurt the provision of basic healthcare services.

#socialneeds #medicaid #khn

Link to Article

Sanders Justifiably Irate On Drug Prices

Brand Drug Maker CEOs will definitely be on the hot seat when they appear before Chairman Bernie Sanders, I-VT, and the Senate HELP Committee.  A new Democratic staff report ( https://www.help.senate.gov/imo/media/doc/big_pharmas_business_model_report.pdf  ) attacks three brand drug makers for obscene profits, dividends, executive compensation and stock buybacks, while having huge price tags and inflation for drugs. It notes that all the goodies for executives and investors can exceed research and development investments. It also recounts how drug prices in America are markedly higher and therefore so are profits. It says that price divergence for existing drugs between America and other developed countries has grown over time with absurd annual price increases. Launch prices have also grown over time. It also accuses these drug makers of patent gaming. 

The report is a great read. Hearing is Thursday.  Get the popcorn ready. As for the Republicans, most of them don’t seem to get the outrage of the American public over drug prices.  It is a shame.

I likely will do a blog on this subject soon. Here is a drug pricing blog I did: https://www.healthcarelabyrinth.com/inflation-reduction-acts-medicare-price-negotiations-should-have-small-impact-on-innovation-but-positive-impact-on-american-lives-and-what-we-pay/ .  Here is one of my podcasts on drug pricing: https://www.healthcarelabyrinth.com/5-modeled-in-part-on-processes-in-other-developed-countries-the-medicare-drug-price-negotiations-should-save-money-promote-better-outcomes-and-have-little-impact-on-innovation/

#drugpricing #ira #branddrugmakers

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Primary Care In America In Crisis

A new study, detailed in a Health Affairs Forefront Blog, indicates that the primary care system in the U.S. is in crisis and suffers from insufficient funding, workforce shortages, and declining access.  It advocates for comprehensive scorecarding to help improve primary care in America. It is clear that we are already far behind other developed countries and this news bodes ill for the future. In my book, The Healthcare Labyrinth (available at this site), I argue that the need to invest in health, wellness and prevention is one of the legs of a three-legged stool to reform American healthcare (the other two legs are reform price and ensure affordable universal access).

Report here: https://www.nationalacademies.org/our-work/implementing-high-quality-primary-care

(Report and article may require a subscription.)

#primarycare #prevention #healthcare #healthcarereform

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Great Piece On Why Another Aduhelm Fiasco May Be Imminent

A great piece in STAT about the Aduhelm fiasco at the Food and Drug Administration (FDA) and why something just like it could happen again. It is hard to take on the establishment, but Professor Jason Karlawish does it here and well. Much of this is about the revolving door between Big Pharma and the FDA and a culture of favoritism.

(This article appears publicly available without subscription.)

#aduhelm #drugpricing

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Are Employers Liable For Bad Drug Deals?

Interesting twist on high drug prices.  An employee is suing her employer for what she alleges is overpaying the employer group’s pharmacy benefits manager (PBMs), which leads to increased costs for workers.  An interesting theory: does an ERISA employer group have a fiduciary duty to ensure the best prices out there to the employer and employees?  The employer in this case is Johnson & Johnson, a brand drug maker that collaborates in the opaque system and may actually increase costs downstream when it enters into rebate and other deals with PBMs.  Ah, the irony of it all! What did Shakespeare say about one being hoist with his own petard?

#drugpricing #brandrugmakers #pbms

Link to Article

— Marc S. Ryan

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