Cigna Closes $3.3 Billion Deal To Sell MA Business
Cigna officially closed its $3.3 billion sale of its Medicare line of business to Health Care Service Corporation (HCSC). The deal includes Medicare Advantage (MA) lives, Medicare Part D lives, its Medicare supplement business, and its CareAllies physician ownership. HCSC jumps to 950,000 members from about 240,000 members. Cigna actually grew MA from about 600,000 to 700,000 in the past year. Cigna CEO David Cordani was known to be frustrated with the lack of profitability in the MA line and wants to focus on services entity Evernorth and the commercial insurance line.
In other news, United’s Optum Rx pharmacy benefits manager (PBM) said it would eliminate up to 25% of reauthorizations, initially focusing on 80 drugs. This amounts to 10% of overall prior authorizations.
Additional articles: https://www.fiercehealthcare.com/payers/cigna-closes-33b-sale-medicare-plans-hcsc and https://www.beckerspayer.com/m-and-a/cigna-hcsc-close-3-3b-medicare-advantage-sale/ and https://www.fiercehealthcare.com/payers/optum-rx-reduce-reauthorizations-80-drugs and https://www.modernhealthcare.com/insurance/optumrx-drug-prior-authorization and https://www.healthcaredive.com/news/optum-rx-eliminate-prior-authorizations/742910/ and https://www.beckerspayer.com/payer/optum-rx-to-eliminate-prior-authorization-for-80-drugs/
(Some articles may require a subscription.)
#cigna #medicareadvantage #hcsc #unitedhealthcare #pbms #priorauthorization
https://www.modernhealthcare.com/mergers-acquisitions/cigna-hcsc-medicare-sale-closed
AI Regulation Should Be Risk Based
Healthcare groups have laid out a fundamental principle on which it says the Trump administration can base its regulation of artificial intelligence tools. The groups say regulations should be based on the risk individual technologies pose to patients and data security.
(Article may require a subscription.)
#ai #healthcare #regulations
Trump Officials To Meet With Stakeholders on Medicare GLP-1 Access
The Office of Management and Budget (OMB) will meet with stakeholders arguing both for and against the expansion of Medicare Part D coverage to individuals who are obese but do not have other underlying disease states.
Health plans and pharmacy benefits managers (PBMs) argue the cost of the expansion could drive spending dramatically. This could endanger the stability of the standalone Part D program and further impact Medicare Advantage (MA) finances. The opponents also argue that the Centers for Medicare and Medicaid Services (CMS) under Biden overstepped regulatory authority when it redefined obesity. It would likely challenge the expansion in court and win based on recent court decisions involving regulations.
Of course, brand drug makers love the expansion given the $1,000 or more gross monthly list prices.
(Article may require a subscription.)
#drugpricing #partd #medicareadvantage #glp1s #weightlossdrugs
https://insidehealthpolicy.com/daily-news/pbms-insurers-argue-against-cms-coverage-weight-loss-drugs
Purdue Pharma Wants Bankruptcy Judge To Bless New Settlement
Purdue Pharma, one of the drug makers that created the opioid crisis in America, wants a bankruptcy judge to bless the latest version of its plan to settle thousands of lawsuits. The last one was thrown out because it sought to hold the Sackler Family (which created the company) from future lawsuits. The family would pay up to $7 billion of the $7.4 billion settlement.
My view is that this settlement is still unfair for the misery caused by the Sacklers. The family would continue to be billionaires, while those impacted receive minor payments. The family members involved should be civilly and criminally prosecuted.
Additional article: https://thehill.com/policy/healthcare/5203445-purdue-pharma-asks-bankruptcy-judge-to-accept-new-settlement-plan/
#opioids #settlement #healthcare
Nine States Could Entertain Work Requirements in Medicaid
Health policy analyst KFF says at least nine states could push to implement work requirements for their Medicaid programs if Congress adopts work requirements as budget reconciliation savings.
#medicaid #coverage #workrequirements #budgetreconciliation
https://www.beckerspayer.com/policy-updates/states-renew-push-for-medicaid-work-requirements
Price Transparency Analyses
Three interesting Health Affairs Forefront blogs. The first looks at the recent Trump executive order seeking to expand price transparency’s existing rule. The second has a number of recommendations based on the existing challenges.
On another notes, a blog outlines the current state of all the litigation against the Trump administration regarding healthcare reductions, including the funding freezes and caps on indirect costs of grants from the National Institutes of Health (NIH).
Additional articles: https://www.healthaffairs.org/content/forefront/new-executive-order-outlines-next-steps-health-care-price-transparency and https://www.healthaffairs.org/content/forefront/improving-price-transparency-data-recommendations-practice
(Articles may require a subscription.)
#healthcare #pricetransparency #doge
https://www.healthaffairs.org/content/forefront/litigation-over-federal-funding-health-programs
— Marc S. Ryan
