CMS Loses Again In Court On Stars
A just released court decision gives the Centers for Medicare and Medicaid Services (CMS) yet another defeat on how the agency runs the Stars program.
Judge Jeremy Kernodle, of the U.S. District Court for the Eastern District of Texas, ruled CMS violated the Administrative Procedures Act of 1946 by improperly reviewing UnitedHealth Group’s health plan call center ratings.
The judge was rather biting in his assessment. He said that CMS creates the guidelines, identifies the phases, and specifies the criteria for the call center metrics. He concluded that the responsibility for any unreasonable or absurd outcomes therefore lies with the agency not plaintiffs. Other lawsuits have been filed by Humana, Centene and Elevance Health.
This could likely lead to recalculations for many plans, although it will not rise to the mass recalculation we saw in 2024.
CMS says it is looking to deprioritize the measures anyway. The lawsuit likely expedites such a sunset.
#cms #stars #medicareadvantage
CMS Announces Movement Of People From Medicaid To Exchanges
For the first time, we are learning the number of people who migrated from Medicaid to the Exchanges after redeterminations were re-introduced. About 2.4 million people transitioned from Medicaid to the Exchanges. About 25 million lost coverage during redetermination, some of whom reapplied and regained coverage. The Medicaid rolls are down almost 15 million from the COVID peak. What is interesting is that the uninsured rate has not increased due to redeterminations, meaning many found coverage elsewhere.
In other news, CMS says almost 500,000 new consumers selected a 2025 Affordable Care Act (ACA) plan through healthcare.gov or a state-based exchange since Nov. 1. About 2.5 million current enrollees have re-signed.
Additional articles: https://insidehealthpolicy.com/daily-news/cms-highlights-500k-new-enrollments-first-snapshot-oe-12 and https://www.cms.gov/newsroom/press-releases/over-496000-new-consumers-selected-affordable-health-coverage-aca-marketplace and https://www.cms.gov/newsroom/fact-sheets/marketplace-2025-open-enrollment-period-report-national-snapshot
(Some articles may require a subscription.)
#medicaid #redeterminations #exchanges
President-Elect Donald Trump Picks Marty Makary To Run FDA
Donald Trump made a great choice in nominating Dr. Marty Makary to run the Food and Drug Administration (FDA).
I have gotten to know Makary in a small way. Makary is a surgeon and renowned health researcher and writer. His intelligence and experience are impeccable.
He will be a tremendous steward over the FDA, which in my view is a badly broken agency with a revolving door that means the health and safety of America takes a back seat. Makary will bring common sense and reform to the agency. He will prioritize the safety and health of Americans.
Congratulations Marty! Well-deserved and this is a great public service you are doing here.
#fda #trump #election2024 #healthcare
https://www.medpagetoday.com/washington-watch/fdageneral/113078
Employers Struggling With Drug Costs
A new Mercer study shows that employer-sponsored insurance costs rose about 5% in 2024, driven in part by coverage of expensive weight loss medications. Mercer surveyed 2,194 employers with at least 50 employees from June 12 to Aug. 16. Employers are spending an average of $16,501 on health insurance per employee in 2024. This will rise by 6% in 2025. This is in line with the 6% to 8% projections from other analysis firms.
Drugs costs are the fastest growing area of growth, rising 7.7% in 2024. GLP-1s are contributing to the rise. Mercer found that almost all employer plans covered GLP-1s for diabetes, with 44% of employers with 500 or more employees offering coverage for obesity.
#weightlossdrugs #glp1s #drugpricing
KFF Glosses Over Some Standalone Part D Plan Negatives
I am not sure what is happening with the Kaiser Family Foundation (KFF). As with its analysis of Medicare Advantage (MA), KFF seems to be glossing over the really bad impacts to consumers in the standalone Part D plans for 2025. Like the Centers for Medicare and Medicaid Services (CMS), it touts the lower cost-sharing from the Inflation Reduction Act (IRA) as well as relatively good choice and low premiums. But to some degree they come clean a bit on their report on standalone Part D plans.
It does point out some negatives:
- That the number of firms offering stand-alone PDPs has dropped from 11 in 2024 to 7 in 2025.
- That the reduction in the overall number of PDPs is down from 709 to 464.
- That an estimated 1.1 million Low Income Subsidy (LIS) enrollees (26% of all LIS PDP enrollees) need to switch plans during the 2024 open enrollment period if they want to be enrolled in a benchmark plan in 2025.
- That the share of MA-PD enrollees who will be in plans that charge a deductible for Part D coverage will nearly triple from 21% in 2024 to 60% in 2025 if they do not switch plans.
- That many Part D enrollees will face coinsurance rather than copayments for both preferred brands and non-preferred drugs.
- That 6 in 10 MA-PD enrollees will be in plans that charge a deductible in 2025, up from 1 in 5 in 2024. In addition, the average deductible is increasing four-fold.
- That a majority of PDP enrollees will be in a plan that charges a drug deductible in 2025, including three-fourths who will be in a plan that charges the standard deductible of $590.
- That a larger share of MA-PD and standalone PDP enrollees face higher cost-sharing for preferred and non-preferred brand drugs.
As the primer healthcare research organization, it has an obligation to say more. The impacts are major in many states. And the IRA changes literally will mean the standalone PDP program could be devastated financially when the extra-legal premium stabilization program ends in 3 years.
#medicareadvantage #pdp #partd #medicare #ira
— Marc S. Ryan
