United Moving To Transparency For Its PBM
UnitedHealth Group Inc. said it will change its profit structure at pharmacy benefits manager (PBM) Optum Rx. The company handled about 1.7 billion prescriptions last year. Optum Rx plans to shift to a more transparent fee structure that gives clients clarity into payments the PBM gets from drug makers.
CVS Health Corp’s Caremark earlier said it would change how it pays pharmacies to make it simpler and more transparent. Cigna’s Express Scripts late last year said it will phase out rebate payments in many private health plans.
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#pbms #drugpricing
https://www.modernhealthcare.com/insurance/mh-unitedhealth-optum-rx-pbm-model
Kaiser Q1 Profit Down
Kaiser Permanente’s Q1 operating performance took a step back in 2026 compared to Q1 2025, although investments and other sources of income offset the bad news. Non-profit Kaiser booked over $2 billion in profit. The integrated delivery system and health plan reported operating income of $711 million for the quarter, or a 2.1% operating margin.
#healthplans #kaiserpermanente #margins
Brookings Publishes NSA Dispute Data
The Brookings Institution has published data on the No Surprises Act dispute resolution process. The estimates use dispute-level data published quarterly by the Centers for Medicare and Medicaid Services (CMS).
#nsa #nosurprisesact
https://www.brookings.edu/articles/no-surprises-act-arbitration-databook/
Fierce Details Health Plan CEO Comp
Despite facing financial woes, CEOs of major healthcare firms largely stayed steady in their compensation for 2025. Fierce looked at annual proxy filings from the six major national payers. Collectively they earned a total of $190.5 million in compensation last year. UnitedHealth Group CEO Stephen Hemsley carries a unique compensation package that skews this year’s report.
#healthplans #compensation
https://fiercehealthcare.com/payers/heres-what-ceos-major-profit-payers-earned-last-year
Exchange Woes
The Hill details the various woes in the Exchanges, including lower enrollments for January 1, further expected declines due to non-payment of premiums, and large numbers of people switching to less generous, high-deductible bronze plans. All this creates concerns about stability.
#exchanges #coverage #healthcare
https://thehill.com/policy/healthcare/5870619-obamacare-enrollment-decline-gop-cuts/
— Marc S. Ryan
