Health Plan Weekly

In its latest earnings release, The Cigna Group reported that it recorded a 27% year-over-year increase in revenue 2024. But the insurer’s stock took an 11% tumble on news that it missed its fourth-quarter adjusted earnings per share (EPS) and medical loss ratio (MLR) targets due to unexpected pressures faced by its stop-loss product.  

Overall, “Cigna reported very weak 4Q24 results,” Leerink Partners’ Whit Mayo concluded.  

Cigna’s fourth-quarter adjusted EPS was $6.64, which was 15% below the consensus estimate of $7.82. And the company’s MLR for the fourth quarter was 87.9%, which was considerably higher (worse) than the 84.4% consensus.  

Massachusetts Gov. Maura Healey (D) this month signed a bill into law that places more scrutiny on private equity investments in health care, joining other states and the federal government in examining PE’s role in the industry. The legislation primarily will impact health care providers, but attorneys and analysts tell AIS Health it could also affect payer transactions, particularly those involving insurers buying provider groups. They also say the law could indirectly impact insurers during reimbursement negotiations with hospitals and other physician groups, as research has found PE-backed providers often extract significantly higher rates than independent physician practices.   

Around 19% of claims from federally facilitated exchange plans were denied in 2023, according to data from a recent KFF report. Experts say the report illustrates a greater need for more data reporting and transparency from Affordable Care Act exchange plans, especially at the state level. 

The publicly available data in the report only applies to qualified health plans sold on HealthCare.gov, which are required to report certain transparency data, including claim denial rates. The report does not include state-run exchanges, Medicare or employer-sponsored plans — meaning it covers a “very small sliver” of the health insurance market, says Michelle Long, report co-author and senior policy manager for KFF’s Program on Patient and Consumer Protections. 

The number of prior authorization (PA) determinations made by Medicare Advantage insurers has risen steadily in recent years as enrollment in MA has grown, according to a new KFF analysis.

In 2021, there were 37 million PA determinations, followed by 46 million in 2022 and nearly 50 million in 2023. The increase corresponds to the growing enrollment in MA plans, from 22 million in 2019 to 31 million in 2023.

The Trump administration plans to continue with the Inflation Reduction Act’s Medicare Drug Price Negotiation Program as well as a model to help state Medicaid agencies pay for expensive cell and gene therapies. CMS said in a Jan. 29 statement that the agency “is committed to incorporating lessons learned to date” from the price negotiation program, and CMS will consider “opportunities to bring greater transparency” into the program. On Jan. 17, three days before Trump’s inauguration, CMS released the list of 15 drugs selected for the second cycle of the program. Meanwhile, an HHS spokesperson told STAT that the administration will continue with the Cell and Gene Therapy (CGT) Access Model, which CMS introduced in 2023 and is set to go into effect later this year. Trump’s recent recission of former President Joe Biden’s executive order that led to the creation of the model caused confusion about whether the CGT Access Model would continue during his administration. CMS last month announced the manufacturers of two high-cost sickle cell gene therapies will participate in the model.