payments

What’s All The Clamor Over GLP-1s For Weight Loss?

Hollywood supposedly is addicted to them. More and more Americans are now trying GLP-1s for weight loss. What is happening here with GLP-1s is something repeated often in the drug world. First, what is a GLP-1? The drugs were introduced in the U.S. beginning in the mid-2000s and have been used for those with type 2 diabetes who were overweight. These are a class of drugs that perform much like a hormone called glucagon-like peptide 1. As blood sugars rise in the blood stream, the drugs stimulate the production of more insulin, which lowers blood sugar levels. This is essential for controlling type 2 diabetes. It’s not clear how the GLP-1 drugs lead to weight loss overall, although the drugs do appear to slow the movement of food through the digestive tract and make you feel fuller. How did it become popular for weight loss? Now let’s get into off-label use of

Read More »

Surprise! Surprise! No Surprises Act Favors Providers And Is Driving Up Costs

Since the No Surprises Act (NSA) was passed in late 2020, I have argued that the baseball-style arbitration process is heavily stacked against health plans and favors providers.  The law went into effect on January 1, 2022, with some portions still forestalled by the federal government.  But the main components  that stop surprise billing to patients and the process to settle what is paid by plans to providers has been in force now for about 2 years.  The implementation of the arbitration has been rocky.  The number of cases is demonstrably above what was expected.  That said, more and more data is now available that shows how well providers are doing from the process. In commercial coverage, the main component of the law disallows providers from billing patients for out-of-network services beyond plan outlined in-network cost-sharing for emergency situations, post-emergency stabilization, and non-emergency in-network facility-based procedures where non-network services may

Read More »

The Audacity of Mark Cuban

Mark Cuban is known as a bold entrepreneur — a smart-thinking guy who cuts through all the nonsense to come up with the right solution. But how audacious was he at a recent White House forum when he suggested that federal and state programs as well as employers essentially cut the top three pharmacy benefits managers (PBMs) out of the pharmacy spending equation altogether in favor of a transparent model? However difficult in the short term, I believe the provocative Cuban has the right answer and wants to aggressively go after it. The entrepreneur is a recent entrant into the world of healthcare. His Cost Plus Drug Company (CPD or Cost Plus) is taking the nation by storm by showing how going direct to the manufacturer — and then to the consumer — can make money and lower costs. He would argue it is not a new model in free

Read More »

The Change Healthcare Cyberattack:  What It Is and Its Implications

A number of Healthcare Labyrinth blog readers asked me if I would write on the Change Healthcare cyberattack and its implications. Below is what I have culled together over the past month and my thoughts about what happened and repercussions. I will attempt to write at a high level and not get too technical – in part because details are still scarce. Overview of what happened We are a month into the Change Healthcare cyberattack. On February 21, 2024, Change Healthcare reported that it was a victim of a cyberattack. It appears that the attack was a ransomware attack by the BlackCat organization and affiliates. It is known to target the healthcare industry. Change Healthcare may have paid a ransom of as much as $22 million, but this has not been confirmed. The attackers claimed about six terabytes of PHI and PII data were stolen (this could be tens of

Read More »

Strong Medicare Advantage Enrollment Growth Continued From February To March

In my January 22, 2024 Healthcare Labyrinth Blog ( https://www.healthcarelabyrinth.com/great-news-for-insurers-and-medicare-beneficiaries-january-2023-to-january-2024-medicare-advantage-growth-rebounds/ ), I told you about the exciting news of Medicare Advantage’s (MA) continued strong growth (from January 2023 to January 2024) as well as a nice recovery from a bit of a sluggish increase from January 2022 to January 2023. As I always do, I publish a follow-up blog in the first few months of each year given continuing growth outside of the main enrollment season from October 15 to December 7. This is because of a somewhat recent change that allows members enrolled in a MA plans to change to a different MA plan or go back to traditional Medicare (and also choose a standalone Part D (PDP) plan. This occurs from January 1 to March 31 of each year. Because of this, MA plans continue to advertise vigorously to attract additional members and there is net new enrollment

Read More »

The Trump-Biden Great Entitlement Debate

After promising not to touch Social Security and Medicare throughout his campaign, GOP 2024 candidate and former President Donald Trump seemingly reopened his views on the issue – only to have Biden attack him and then Trump having to clean up after. Here is the back and forth (this could be the only real debate we see from the candidates) : In comments to a journalist on whether he had changed his views on entitlements, Trump declared: “So first of all, there is a lot you can do in terms of entitlements in terms of cutting and in terms of also the theft and the bad management of entitlements, tremendous bad management of entitlements. … There’s tremendous amounts of things and numbers of things you can do. So I don’t necessarily agree with the statement.” It seems reasonably clear that Trump likely was talking about cleaning up administration and fighting

Read More »
Logo

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

Read More »

King Charles’ Cancer Diagnosis Shines A Light On Holes In The U.K.’s Healthcare System – And Ours

In early February, Buckingham Palace announced that King Charles has been diagnosed with cancer. As is often the case for the royals’ personal lives, not a lot is always shared. But the King and his now deceased mother should be congratulated for some of their openness. Like his mother’s announcements when her health was in question, the King’s announcement was meant to encourage everyone to take care and get preventive care performed. At the same time, the King’s announcement has shined a light on some of the problems in the United Kingdom’s healthcare system. As I have covered a few times in my blogs, the U.K. just celebrated its National Health Services’ 75th anniversary of its founding a few years after World War II ended. The U.K. took the socialized medicine approach, where the government funds, directs, runs, and largely provides healthcare services to its citizens. Some other nations in

Read More »
Logo

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

Read More »
Logo

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

Read More »

Available Now

$30.00