Centene Reports Financial Results
Centene Corporation posted a $1.1 billion loss in Q4 2025 and $6.7 billion loss for 2025 as it sees elevated costs overall and shrinking membership in Medicaid. It had $3 billion in profit in 2024. Its medical loss ratio was 94.3% in Q4, up from 89.6% a year ago. Adversity is increasing.
While it did post a loss in Q4, results still surpassed Wall Street analysts’ predictions. Centene issued a higher earnings outlook for 2026 than analysts expected as well.
As with Molina, which reported negative results for 2025 and financial expectations in 2026 that are half of analyst forecasts, Centene said states’ Medicaid payment rates haven’t kept pace with costs. Acuity is also rising in the Exchanges.
Both Centene and Molina stock dropped.
Additional articles: https://www.modernhealthcare.com/insurance/mh-molina-medicaid-acquisitions-medicare-advantage/ and https://www.modernhealthcare.com/insurance/mh-centene-earnings-medicare-medicaid/ and https://www.healthcaredive.com/news/centene-loss-q4-2025-2026-outlook-cnc/811564/ and https://www.beckerspayer.com/financial/centene-posts-6-7b-loss-in-2025/
(Some articles may require a subscription.)
#healthplans #margins #centene #molina #medicaid #exchanges
Cheering PBM Reforms And More To Come
Healthcare advocates and many in the drug chain are cheering the major pharmacy benefits manager (PBM) reforms included in the FFY 2026 funding package. They include extensive reporting, transparency, and government oversight as well as requirements to pass rebates earned from drug makers to health plans, employers, and patients. PBMs will now have to charge a set fee for services.
But some in Congress are talking about even more extensive reforms broadening the bill’s reforms. And many want to target PBM’s ownership of group purchasing organizations, including concerns about the subsidiaries’ opaque structures, apparent enormous profitability and in some cases, their overseas locations. Critics argue these GPOs show how creative PBMs have been at finding loopholes to get around transparency and hide profits.
Additional article: https://www.modernhealthcare.com/politics-regulation/mh-congress-pbm-reform-gpo-subsidiaries
(Some articles may require a subscription.)
#pbms #drugpricing
FDA Says It Will Rein In Illegal Copycats
Food and Drug Administration (FDA) Commissioner Dr. Marty Makary, M.D., said Thursday that his agency will take swift action against companies’ mass marketing illegal copycat drugs. His declaration comes one day after brand drug maker Novo Nordisk announced its intention to sue Hims and Hers over its planned marketing of one of these copycats to compete with the brand maker’s new GLP-1 weight-loss pill. The FDA says it cannot verify the effectiveness and safety of such drugs.
#brandrugmakers #drugpricing #glp1s #weightlossdrugs
Wyden Blasts TrumpRx
Sen. Ron Wyden, R-OR, blasted the direct-to-consumer (DTC) TrumpRx website as nothing more than a “glorified coupon book.” While I have not agreed with all of President Trump’s healthcare policies, I do give him credit on drug pricing.
Whatever one thinks of TrumpRx in isolation, there is no question the negotiations with drug makers and concessions, Trump’s embrace of the Biden Medicare drug price negotiations, and the two most-factored-nation (MFN) models proposed represent seminal change – change no other president or Congress has proposed.
One real point has arisen. The site advertises discounts on brand drugs that do have generics as well. While price concessions on true brands (no competition) are real, the concessions on brands with generics out there do not net out below most generic prices. That is a source of confusion and is misleading to consumers.
#drugpricing #trumprx #branddrugmakers
https://thehill.com/policy/healthcare/5726644-trump-rx-senator-wyden-criticism
— Marc S. Ryan
