Bad News on 2025 Medicare Advantage Begins To Roll Out
Humana has reaffirmed its full-year guidance but gave details on the retrenchment it is doing in Medicare Advantage (MA) for 2025. As expected, Humana announced the paring back of benefits, higher premiums, and the exit from geographies.
Humana is leaving 13 markets next year because they are not profitable or poorly profitable. In other areas, Humana is staying in but eliminating certain plans with high medical expense, which will diminish choices. Humana says about 560,000 members, or 10% of its individual MA enrollment, would be impacted by the cutbacks. About half of those will stay in Humana in other plans. That is about what Humana said it would lose earlier this year – a couple hundred thousand members.
Other big plans are cutting back, too. Centene is leaving certain markets, cutting benefits, and raising premiums. Even Humana, who is bullish on MA in 2025, will pare back.
Additional article: https://www.modernhealthcare.com/insurance/humana-medicare-advantage-markets-2025
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#medicareadvantage #humana
https://www.fiercehealthcare.comV/payers/humana-exiting-medicare-advantage-13-markets
GLP-1 Costs Could Crash Medicare
Congress is debating an expansion of weight-loss drugs in Medicare, but a new study shows just how costly the move could be.
The Centers for Medicare and Medicaid Services (CMS) has already begun covering the drugs for those with diabetes and cardiovascular disease. Congress is looking at a small expansion for those who are overweight or obese and continuing therapy from commercial coverage.
The study finds Wegovy’s inclusion in Part D for cardiovascular risk reduction could cost up to $145 billion annually alone. The study estimates that approximately 3.6 million adults would qualify for semaglutide coverage under CMS’s new guidelines. The coverage population could jump to 15.2 million adults if broader definitions are applied.
Centene also said that GLP-1 medication costs are contributing to tighter margins in the Medicaid space.
Additional article: https://insidehealthpolicy.com/daily-news/study-medicare-coverage-novo-nordisk-s-semaglutide-cvd-could-reach-145-billion-annually and https://www.beckerspayer.com/payer/centene-glp-1s-a-factor-behind-medicaid-pressure.html
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#weightlossdrugs #glp1s #partd #pdp #medicareadvantage
Drug Prices Still More Than Double for Medicare Drugs Negotiated
A Reuters review found that the ten drugs with new negotiated prices in Medicare Part D are still on average more than double, and in some cases five times, what drugmakers get paid in four other high-income countries — Australia, Japan, Canada and Sweden. I made these points in a recent blog here: https://www.healthcarelabyrinth.com/the-big-pharma-apocalypse-did-not-happen/
#drugpricing #ira #branddrugmakers
— Marc S. Ryan
