June 18, 2024

Major Developments In Direct To Consumer Pharmacy Market

Two major developments in the direct-to-consumer pharmacy market. A study published in the JAMA Health Forum suggests that most people that are insured are better off going through their insurance than through Mark Cuban’s Cost Plus Drug Company, although some deals are better for certain medications for the insured and those uninsured benefit.  I am not sure the purpose of the story. Of course, insurance should be a better deal than not going through insurance.  But the fact is that often Cuban’s outfit can offer better deals due to the opaqueness of the drug supply channel. The fact that 100 million of 844 million prescription fills (of 124 generic drugs) would have been cheaper under Cuban’s paradigm than insurance proves the system needs reform. Cuban is on to something.

In other news, Amazon Pharmacy has extended Amazon Pharmacy Rx Pass membership to Medicare enrollees. RxPass subscribers pay $5 a month to fill as many prescriptions as needed from a list of about 60 generic medications, including delivery to their doorstep.

Additional articles: https://www.fiercehealthcare.com/payers/mark-cubans-d2c-pharmacy-wont-beat-most-insured-patients-out-pocket-drug-prices-study-finds and https://thehill.com/policy/technology/4727072-amazon-pharmacy-expands-medicare-rxpass/

#drugpricing #cuban #pbms


Novant Health Ends Hospital Pursuit After FTC Court Win

Novant Health ended its deal to acquire two North Carolina hospitals from Community Health Systems after a federal appellate court agreed with the Federal Trade Commission (FTC) and stopped the acquisition.  I am a supporter of greater FTC scrutiny of hospital consolidations given they bring higher costs and no measurable increase in quality. But I did think the lower court judge’s decision on why the merger should be allowed made sense.

(Article may require a subscription.)

#manda #hospitals #mergers #consolidations #ftc


Uninsured Rate In 2023 Dropped, But On Way Up Over Next Decade

Major reports on the uninsured rate in America. According to the Congressional Budget Office (CBO), the uninsured rate is 7.7% this year, with 26 million people without insurance. This is up from an all-time low of 7.2% in 2023. CBO says the uninsured rate will rise to 8.9% in 2034, largely due to erosion in Medicaid coverage due to the redeterminations re-introduced post COVID and the expected end of the enhanced premium subsidies in the Exchanges that has driven a great deal of enrollment.

The projected 8.9% uninsured rate in 2034 would be higher than before the COVID-19 pandemic but represents great progress than before the Affordable Care Act (ACT) passed in 2010 and coverage expansion began in 2014.

Separately, the Centers for Disease Control and Prevention (CDC) issued a separate report showing the uninsured rate for all U.S. residents was 7.6% in 2023, down from 8.4% the year before. These number vary slightly from the CBO report. CDC says 25 million people in the U.S. in 2023 had no health insurance. In 2019, 33.2 million people were uninsured, or 10.3%. That is a drop of about a quarter in four years.

In another analysis, the Urban Institute (for the Robert Wood Johnson Foundation) says that the enhanced premium tax credits will roughly double those enrolled in Exchange plans and reduce the number of uninsured in five southern states (TX, SC, MS, LA and GA) in 2025 compared to without premium enhancements. Overall, the enhanced premium subsidies will mean a 14% decrease in uninsured Americans and a 71% increase in Exchange enrollment in 2025.  Of course, all this is reversed if the enhancements terminate.

Additional articles: https://insidehealthpolicy.com/daily-news/rwjf-aca-tax-credits-will-cut-uninsured-hike-enrollment-five-southern-states-2025 and https://www.beckerspayer.com/payer/us-uninsured-population-drops-to-25-million.html and https://www.modernhealthcare.com/policy/cbo-national-uninsured-rates-medicaid-2034-cdc

(Some articles may require a subscription.)

#healthinsurance #healthcare #coverage #uninsured


— Marc S. Ryan

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