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March 14, 2024

Change Pharmacy Network Back On While insurtechs overall have struggled, at least three – Alignment Healthcare, Devoted Health, and Clover Health – appear to be doing well.  Clover Health had an adjusted EBITDA loss of $19.1 million in the fourth quarter and a full-year loss of $44.7 million last year.  This is significantly better than in 2022. Its medical loss ratio (MLR) is projected to be just 81.2% for 2024. It expects adjusted EBITDA profit up to $20 million. Since it began, it, too, amassed a sizeable membership. #clover #insurtechs Link to Article Federal Appeals Court Deals Drug Makers A Blow On 340B A federal appellate court said that a state law could be reconciled with the federal 340B drug discount program. Drug makers are fighting to rein in the discounts they give to various pharmacies and hospitals.  While I find Big Pharma’s constant lawsuits defending their unreasonable pricing system

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March 13, 2024

Clover Health Readying For Positive Margin While insurtechs overall have struggled, at least three – Alignment Healthcare, Devoted Health, and Clover Health – appear to be doing well.  Clover Health had an adjusted EBITDA loss of $19.1 million in the fourth quarter and a full-year loss of $44.7 million last year.  This is significantly better than in 2022. Its medical loss ratio (MLR) is projected to be just 81.2% for 2024. It expects adjusted EBITDA profit up to $20 million. Since it began, it, too, amassed a sizeable membership. #clover #insurtechs Link to Article Feds Investigating Change Healthcare The federal government has launched an investigation into UnitedHealth Group and its Change Healthcare subsidiary after a major cyber attack.  While I am always weary of government investigations based on headlines, in this far-reaching incident it is important to understand what happened and whether there was negligence.  In related news, major for-profit

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March 12, 2024

UnitedHealth Group CEO Hears From Becerra And Providers At an unprecedented meeting, UnitedHealth Group CEO Andrew Witty heard from both Health and Human Services (HHS) Secretary Xavier Becerra and providers at a government sponsored meeting. The plea was for United to take responsibility for the Change Healthcare cyber attack and give        additional financial support to providers. In addition, HHS detailed more about what a $1.3 billion fund for cyber security would be used for.  About 2,000 hospitals will receive incentive funds to adopt new cyber security practices. Another $153 million would go for various government initiatives. Additional article: https://www.fiercehealthcare.com/providers/becerra-stakeholders-its-time-take-accountability-cybersecurity #changehealthcare #unitedhealthcare #cyberattacks Link to Article New Study Says Provider Email Claims Largely Require No Patient Cost-Sharing A new study says that less than 20% require a patient to pay out-of-pocket for so-called “email messaging” claims. Those that did paid a median of $25 per claim. Good summary of the

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March 11, 2024

Biden Releases His FFY 2025 Budget The President announced his FFY 2025 budget even as all bills for the current FFY 2024 year have not been approved (including Health and Human Services spending).  Biden did sign into law the bill that funds some agencies for the current fiscal year, including a partial retreat on a major Medicare doc cut. Because of the split in Congress, most of his proposals are dead on arrival but serve as campaign differentiators against his GOP opponent, former President Donald Trump. In the FFY 2025 budget, Biden funds the commitments he made at the State of the Union and more: Additional articles: https://www.modernhealthcare.com/politics-policy/biden-budget-cybersecurity-insurance-subsidies and https://insidehealthpolicy.com/health-insider/admin-releases-budget-addresses-fallout-over-change-healthcare-attack and https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more (Some articles require a subscription.) #budget2025 #healthcare #healthcarereform Link to Article Change Healthcare Cyber-Attack Update The Department of Health and Human Services (HHS) urged UnitedHealth Group and other payers to provide financial assistance to providers impacted by the

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March 8, 2024

Biden SOTU Address Fiery And With Major Expansion Requests President Joe Biden gave a fiery campaign speech at the State of the Union Thursday.  He touched on policy changes he wants to see across government and society.  In the healthcare world, he asked for significant additions to what he thinks is his successful record: Additional articles: https://www.fiercehealthcare.com/payers/biden-call-drug-negotiation-expansions-stronger-reproductive-care-access-sotu and https://insidehealthpolicy.com/daily-news/biden-advocates-expansion-drug-price-controls-aca-state-union and https://www.modernhealthcare.com/politics-policy/joe-biden-state-union-sotu-2024 (Some articles may require a subscription.) #biden #sotu #healthcare #healthcarereform #aca #obamacare #exchanges #drugpricing #ira #coveragegap #insulin Link to Article Change Healthcare May Need Until Mid-March To Fully Restore All Services While some services have been restored, Change Healthcare says all services may not be restored until mid-March.  Meanwhile, class-action lawsuits are beginning to be contemplated.  Major parts of health plan and provider services have been impacted. Additional articles: https://www.fiercehealthcare.com/payers/optums-change-healthcare-responding-cybersecurity-issue and https://www.modernhealthcare.com/cybersecurity/change-healthcare-update-systems-online-march15 (Some articles may need a subscription.) #changehealthcare #cybertattacks Link to Article Sanders Asks Other Drug Makers To

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March 7, 2024

Almost 18 Million Initially Lost Medicaid Coverage During Redeterminations The Kaiser Family Foundation reports that almost 18 million initially lost coverage during Medicaid redeterminations.  Some regained eligibility later.  Most lost coverage on procedural grounds.  Enrollment has dropped by about 10M so far in Medicaid nationwide. #medicaid #redetermintations Link to Article Evernorth Continues Growth Cigna’s Evernorth service subsidiary continues its growth. It announced an expansion to its GLP-1 management solution as well as the launch of a new behavioral-health-focused medical group. #cigna #evernorth Link to Article Biden To Propose Major Expansion Of Healthcare Initiatives President Biden will propose major healthcare expansions in his State of the Union Address tonight.  Among other things, a Fact Sheet says he will propose an expansion of Medicare drug price negotiation (500 drugs negotiated over the next 10 years), permanent expansion of enhanced premium subsidies in the Exchanges, a special program for those in the coverage

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March 6, 2024

Walgreens Will Have Long Road To Recovery Walgreens says that its road to financial recovery will be long – not a 12-month plan.  It is undertaking a strategic review of its business. It plans to cut $1 billion in expenses this year.  Additional article: https://www.modernhealthcare.com/providers/walgreens-tim-wentworth-villagemd-shields-health-ownership (Some articles may require a subscription.) #walgreens Link to Article Major Claims Reductions Reported In Light of Change Healthcare Cyber Attack While UnitedHealth Group remains mum, Humana and Elevance Health say they are seeing a 15% to 20% reduction in data from providers since the Change Healthcare cyber attack. The rate of reduction is now down to 10% as providers and plans adapt to the outage from Change. Plans are adopting a reserve strategy to ensure a set aside for such claims in the future. Change Healthcare/Optum will likely lose a great deal of business as providers and plans lose faith in Change and migrate to other

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March 5, 2024

Cuban Recommends Radical Change In Drug World To Reduce Costs I am a big fan of Mark Cuban and what he and his Cost Plus Drugs are doing to reform the drug price system.  So when he speaks, I listen.  At a White House round table, Cuban proposed that federal programs cut off all ties to traditional pharmacy benefits managers (PBMs) and embrace full transparency.  He has a direct-to-consumer firm and various transparent PBMs are all in on this idea.   The White House liked the transparency idea but knows it is easier said than done and there are many barriers to unravel what we have now. I note that the transparency model emerging right now works well for generic drugs, but it will be harder and take more time for brand drugs, especially until we get prices lower and solve for the shadowy rebate system. But Cuban’s transparency and

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March 4, 2024

FFY 2024 Spending Package Agreed To By Key Lawmakers A bipartisan spending bill has been agreed to by key lawmakers and will need to be voted on in each House.  The package basically cuts in half the Medicare doc fix cut of 3.4%, pushes back scheduled disproportionate share hospital (DSH) payment cuts, and increases annual funding for community health centers. Accountable Care Organizations’ (ACOs) bonus program was also protected. Absent from the bill are major healthcare reforms. Docs are not very happy with the partial fix and no total overhaul of their rates. Additional articles here: https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more and https://insidehealthpolicy.com/health-insider/lame-duck-battle-looms-health-wins-skinny-bill-expiring-december and https://insidehealthpolicy.com/daily-news/skinny-health-package-scales-back-doc-fix-adds-chc-funding and https://www.medpagetoday.com/practicemanagement/reimbursement/109008 and https://thehill.com/policy/healthcare/4507164-government-funding-bills-leave-out-phamacy-benefit-manager-industry-changes-as-white-house-mulls-reforms/ (Some articles may require a subscription.) #governmentshutdown #healthcare Link to Article All Drug Makers Submit Counter Offers In Medicare Drug Price Negotiations The White House announced that all ten companies involved in the initial Medicare drug price negotiations have sent in counter proposals to what

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March 1, 2024

Medicare Advantage Will Remain Viable Over The Long Run Good article in Modern Healthcare discussing the fact that, while there will be major bumps in the road, Medicare Advantage (MA) will remain viable and strong.  A great quote from Paul Ginsburg, senior fellow at the University of Southern California Schaeffer Center for Health Policy and Economics. “We’re not talking about any risk to the financial integrity of these companies at all. The Medicare Advantage business is very viable long-term because they’re providing something that more and more Medicare beneficiaries are deciding they want,” Ginsburg said. “Will it be as great for the next few years as it has been? Probably not. It’ll still be very good, though.” This echoes what I said in a January 29, 2024 blog ( https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ ) as well as a February 9 Podcast ( https://www.healthcarelabyrinth.com/9-is-medicare-advantage-exploding-after-its-boom-or-simply-adjusting/ ). As I say, the real victims of terrible policies

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