healthcarereform

Review Of Healthcare Consolidation Excellent Health Affairs Forefront Blog on the impacts of healthcare consolidation. A good read. As the authors note: The authors recommend a series of changes to strengthen oversight: (Article may require a subscription.) #antitrust #manda #acquisitions #mergers #healthcare https://www.healthaffairs.org/content/forefront/rise-health-care-consolidation-and-do 2025 Medicare Advantage Benefit Anxiety Two articles that show the rising anxiety over potential reductions in Medicare Advantage (MA) as well as Part D. Health plans are emphasizing the need for education. Predictions are that consumers will attempt to emphasize consistency over new innovations in benefits. Plans will need to build closer relationships with providers as well as emphasize care and risk management. Additional article: https://www.beckerspayer.com/payer/medicare-advantage-plans-contend-with-election-anxiety.html #medicareadvantage #enrollment https://www.beckerspayer.com/payer/the-great-disruption-coming-for-medicare-advantage.html AMA Study Shows PBM Market Highly Concentrated An American Medical Association (AMA) study says that the four largest pharmacy benefit managers (PBMs) control 70% of the national market related to commercial and Medicare Part D coverage. It also

Oscar Worried About Sunset of Exchange Premium Subsidy Enhancement Insurtech Oscar Health is worried about the potential sunset of the enhanced premium subsidies in the Exchanges. Exchange enrollment has reached 21.3 million with the enhanced subsidies, the loss of Medicaid eligibility through the reintroduction of redeterminations, and general pro-coverage policies of the Biden administration. Oscar could lose 15% to 20% of its enrollment. Oscar is focused on Exchange enrollment. The nation’s uninsured rate has increased already due to Medicaid coverage losses. The increase in the number of uninsured could worsen with the sunset of the enhanced premium subsidies. The Urban Institute found that the enhanced subsidies will lead to 7.2 million more people receiving subsidized Marketplace coverage and 4.0 million fewer people being uninsured in 2025. It also found that the 7.2 million in added enrollment also will reduce insurer premium rates by 5 percent on average. The sunset of

Cigna Focuses On Its Services Entity’s Growth Cigna CEO David Cordani has sent a strong message that Cigna’s focus is on Evernorth, its services entity.  Cordani says its pharmacy benefits manager (PBM), Express Scripts, and specialty pharmacy are strong focuses moving forward. They are both housed in Evernorth. The attention makes sense.  Evernorth has grown tremendously and has been a huge contributor to margin.  The attention to drug costs, including creative ways to address the growth of weight-loss drugs and transitioning to biosimilars, is important.  At the same time, Cigna will see continued political pressure on the market size of its PBM. PBM reform legislation is becoming more and more likley this year. Cigna seems to think the rise of transparency will not disrupt Express Scripts placement in the market right now. Additional article: https://www.beckerspayer.com/payer/cigna-ceo-expect-choppiness-in-glp-1-coverage.html (Some articles may require a subscription.) #cigna #pbms #drugpricing #biosimilars #weightlossdrugs https://www.modernhealthcare.com/insurance/cigna-evernorth-health-services-specialty-pharmacy-pbm-david-cordani-morgan-stanley Centene Continues To Have

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

BEA Finds Drug Price Increase Differences With And Without Rebates Factored In An interesting study from the Bureau of Economic Analysis (BEA), which set out to study whether annual drug price increases are different when factoring in rebates between drug makers and pharmacy benefits managers (PBMs) or health plans. The BEA compared claims data with rebate estimates from 2007 to 2020. It found something very interesting. Retail pharmacy prices increased by 9.1% each year. Negotiated prices, which include rebates, grew a more modest 4.3% per year. The issue here is that rebates do not regularly make it in full or sometimes even in part from the pockets of PBMs to either employer groups or to patients at the point of sale. Pointing to this is the fact that in 2016, patient out-of-pocket spending rose while negotiated cost growth largely remained flat. The increase in out-of-pocket costs is likely attributable to