Exchange Insurers Report On Program Challenges
First quarter results for insurers with Exchange lines of business had two trends. First, there generally was lower enrollment because people exited the market due to surging premiums and expiring subsidy enhancements. Second, people moving to less costly and trimmer Bronze and Catastrophic plans.
The health insurance companies expect aggregate Exchange enrollment will shrink by at least 20% over the course of the year as more drop out due to affordability.
Oscar Health bucked the trend in terms of enrollment growth.
Additional articles: https://www.fiercehealthcare.com/finance/aca-exchanges-dominated-q1-earnings-calls-heres-what-payer-health-system-execs-had-say
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#exchanges #healthplans
https://www.modernhealthcare.com/insurance/mh-aca-enrollment-centene-molina-cigna-oscar
Various Rx Studies and Reviews
A number of blogs and white papers on various pharmacy developments:
- A Health Affairs Forefront blog reviews the proposed prior authorization rule covering drugs in government programs.
- A Health Affairs Forefront blog discusses most-favored nation pricing in America and how it will be influenced by drug makers exiting certain markets in Europe to maintain higher prices in America. Another blog talks about how manufacturers could game the system by entering into private discounts with countries.
- A briefer by healthcare policy group KFF looks at the GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) model. In this voluntary model, participating brand drug makers are offering most-favored-nation (MFN) pricing in the safety net program. The model was just pushed out to allow more drug makers and states to join in. It is unclear how much more savings will be generated in a program that already has large retrospective state and federal rebates.
Additional articles: https://www.healthaffairs.org/content/forefront/understanding-cms-s-proposed-rule-regarding-prior-authorization-drugs and https://www.healthaffairs.org/content/forefront/most-favored-nation-drug-pricing-anchoring-moving-target and https://www.healthaffairs.org/content/forefront/amgen-s-retreat-denmark-repatha-and-collision-course-us-mfn-pricing-policy
(Some articles may require a subscription.)
#priorauthorization #mfn #drugpricing #medicaid #medicare #medicareadvantage #partd
— Marc S. Ryan
