Enrollment Marketing and Fraud Take Center Stage
The lobby representing marketing agents and brokers is blasting Democrats’ legislation that would slap civil or criminal penalties on agents and brokers who submit fraudulent information regarding Exchange enrollment. It points the finger at the federal government for failing to enforce laws to protect consumers.
At the same time, a report from Senate Finance Committee Ranking Member Ron Wyden says Medicare Advantage (MA) insurers are spending an increasing amount on fees and commissions paid to brokers. The report states that MA plans increasingly rely on third-party marketing organizations and lead generators to drive enrollment. Spending on such fees and commissions increased from $2.4 billion in 2018 to $6.9 billion in 2023.
As well, the Paragon Health Institute is citing the indictment of two men for allegedly running a scheme to glean commissions by enticing people to misstate their expected income to gain subsidized enrollment. Paragon says it highlights lax verification policies and fraudulent activities in the Exchanges. Paragon says the verification process should be tightened and enhanced subsidy enhancements should expire at the end of the year.
Additional articles: https://insidehealthpolicy.com/daily-news/doj-indicts-aca-brokers-1619m-enrollment-fraud-paragon-says-enhanced-aca-credits-should and https://www.beckerspayer.com/policy-updates/senate-report-scrutinizes-medicare-advantage-marketing-spend-broker-practices/
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#marketing #medicareadvantage #exchanges #fwa #agents #brokers
Eli Lilly Expands DTC For GLP-1
Eli Lilly is expanding its direct-to-consumer approach by partnering with weight-loss digital health company Noom. Noom will collaborate with Eli Lilly’s pharmacy provider, GiftHealth, to facilitate access to Zepbound single-dose vials. The single dose vials are at a significant discount to the regular brand medication, but still pricey.
#glp1s #weightlossdrugs #branddrugpricing #branddrugmakers
https://www.beckershospitalreview.com/pharmacy/eli-lilly-moves-to-expand-zepbound-access
Hospitals And Providers Bemoan Trump Healthcare Changes
Hospitals and other providers are bemoaning the major changes in healthcare policy in the last roughly 60 days of Trump 47. Among the concerns include the change in communication approaches, the freeze of grants for research, other grant impacts related to hospital projects, and the potential impact of tariffs on provider supplies and drugs.
(Article may require a subscription.)
#hospitals #providers #cms #hhs #trump #healthcare
https://www.modernhealthcare.com/politics-policy/federal-restructuring-staffing-tariffs-grants
— Marc S. Ryan
