February 8, 2024

Weighty Lesson For Employers From NC State Employee Plan Experience On GLP-1 Drugs

A lesson for employer groups as weight-loss drugs take off in popularity.  An analysis of data says that just 25 of over 6,200 prescribers in the North Carolina State Employee Plan accounted for 8 percent of the costs of prescriptions for costly weight loss drugs. These include GLP-1 meds Wegovy and Saxenda. These drugs accounted for 10% of total costs – or over $100 million.

The state wanted to rein in costs with some ideas, but its pharmacy benefit manger shot them down.

Shame on the healthcare players to not work with employers battling these cost issues.

As important, there are telehealth entities now emerging, backed by private equity, advertising solely to prescribe such meds.  It is corrupt.

#weightlossdrugs #drugpricing

Link to Article

Good News From Oscar Health; It Favors ACA Subsidy Extension

Oscar reported major enrollment gains and narrowing losses in 2023.  Oscar is worried though about what happens to the Affordable Care Act (ACA) premium enhancements after 2025.  Premium subsidies would return to the statutory amounts.  It is clear that the enhancements have driven Exchange enrollment as well as coverage in the U.S. (along with the Medicaid expansion).  While I tend to think that the enhancements at the lowest level may be too rich, I do not disagree with making them permanent given the success on coverage. I do think middle-income bands actually need more help.

#oscar #exchanges #aca #obamacare

Link to Article

Like Others, Molina Says MA Rate Hike Will Be Inadequate

At its investor call today, Molina Healthcare joined the chorus of other health plans and said the 2025 Medicare Advantage (MA) advance notice of rates was clearly inadequate, but that it would see a slight increase in overall revenue under the formula. It said its medical expense was well over 90% for the year. It just bought 109K MA lives from Bright Health.  It otherwise reported good 2023 numbers. It said its Medicaid enrollment losses topped 500K due to redeterminations.

Additional article here: https://www.healthcaredive.com/news/molina-redeterminations-losses-2023-earnings/706877/

(Article may require a subscription.)

#molina #medicaid #medicareadvantage

Link to Article

Bipartisan Bill On AI Regulation Could Emerge

The top Democrat and Republican on the Senate Finance Committee want health care-specific artificial intelligence regulation to pass. No word yet on this priority from the Senate HELP committee.

(Article may require a subscription.)

#ai #healthcare

Link to Article

Home Hospital Pilot Could Be Extended

Sens. Tom Carper (D-DE) and Marco Rubio (R-FL) want to extend the acute hospital care at home waiver as a national pilot. With the growth of technology, extending the program past 2024 makes a great deal of sense.  There are some major success stories here, including major investments from forward-thinking hospitals.

(Article may require a subscription.)

#hospitalathome #hospitals #medicare #medicareadvantage

Link to Article

Sanders Rips Drug Maker CEOs At Senate HELP Hearing

I have only been able to see part of it, but HELP Chairman Sen. Bernie Sanders, I-VT, did a good job holding brand drug maker CEOs accountable for the exorbitant prices in the U.S. compared with other developed countries. He even pushed back on the idea from drug makers that this is all the fault of pharmacy benefit managers (PBMs).  Drug makers own and essentially created the rebate system. Even if rebates were netted out of prices in America, prices would still be obscene.

 I was very disenchanted with one of my own party members, HELP committee ranking member Bill Cassidy, R-LA. He stated: “This committee has devolved into CEO whack-a-mole with little to show … if this is just to get social media clips of members taking it to a quote unquote greedy CEO, then I suppose that is what some people want to accomplish.” But what has the GOP offered in the debate other than a vigorous defense of Brand Pharma.  Nothing. The GOP is out of step with the American public on the issue. There were a few Republicans on the committee who were balanced and reasonable, such as Sens. Collins and Braun.

#drugpricing #ira #branddrugmakers

Link to Article

Interesting Reads on Part D Cost Reductions

A good analysis by the Kaiser Family Foundation (KFF) on the benefits of the 2025 $2,000 Medicare Part D cap and how it will reduce costs for well over one million enrollees. This year, the 5% coinsurance in the catastrophic coverage is being eliminated.

A separate article shows how complex the smoothing of member cost-sharing monthly will be.  It questions how effective the new program will be for some, especially based on the Part D cap coming in. It will help some, but perhaps not others.  Some may see an unexpected bill at the end of the year. It suggest some reforms. I am just not sure how good the uptake will be in the smoothing program anyway.

Monthly smoothing of cost-sharing article here: https://www.healthaffairs.org/content/forefront/medicare-part-d-s-new-prescription-payment-plan-may-not-reduce-costs-all

KFF press release on $2,000 cap here: https://www.kff.org/medicare/press-release/new-2000-medicare-part-d-cap-could-reduce-out-of-pocket-drug-costs-for-over-one-million-beneficiaries-beginning-next-year-including-tens-of-thousands-of-beneficiaries-in-most-states/

#partd #medicaredvantage

Link to Article

— Marc S. Ryan

Leave a Reply

Your email address will not be published. Required fields are marked *

Available Now