Health Plan Weekly

Children and adolescents were much more likely to access necessary mental and behavioral health (MBH) services if they lived in states that mandate insurance coverage for mental health care, according to a recent study published in JAMA Network Open.

The study is based on responses from almost 30,000 caregivers of kids and adolescents ages 6 to 17 years with mental and behavioral health conditions in the National Survey of Children’s Health and State Mental Health Insurance Laws Dataset (SMHILD) from 2016 to 2019. The comprehensiveness of state MBH insurance laws was defined by the SMHILD score and categorized as 0 to 2, 3, 4, and 5 to 7.

When CVS Health Corp. announced on Aug. 7 that Aetna President Brian Kane was leaving after less than a year on the job, it highlighted how severe the company’s struggles in its health benefits segment have become. The decision also drew mixed reactions from Wall Street analysts.

Barclays’ Andrew Mok wrote in an Aug. 7 note that Kane’s departure was “a big surprise” and added that Kane “was widely viewed as the fixer for the Medicare Advantage business,” which has been a drag on earnings.

“The accountability here is questionable and the change casts significant uncertainty on whether the company was able to capture developing cost trend pressure in 2025 Medicare bids,” Mok wrote.

While most of the largest managed care organizations have recently reported higher-than-expected utilization that negatively impacted their second-quarter results, the three publicly traded “insurtechs” did not have the same issues.

Ari Gottlieb, principal of health care consulting firm A2 Strategies who has often criticized the financial performance and management of Alignment Healthcare, Inc., Clover Health Investments Corp. and Oscar Health, Inc., tells AIS Health the insurtechs “all posted pretty good quarters” and are headed in the right direction.

While pharmacy benefit managers are no strangers to litigation, in recent weeks there has been a notable uptick in lawsuits that challenge — both directly and indirectly — PBMs’ ability to ensure clients are able to access the lowest possible drug prices. Sources say that as those suits progress, they could wind up shedding greater light on business practices that have caused PBMs to be caught in regulators’ crosshairs.

In mid-July, Vermont Attorney General Charity Clark (D) filed a lawsuit against The Cigna Group’s Express Scripts, CVS Health Corp.’s Caremark, and “nearly two dozen affiliated entities,” accusing them of violating Vermont’s Consumer Protection Act by “manipulating the marketplace and reducing access to certain prescription drugs, including lower-cost drugs, through a series of tactics with no transparency in their decision-making process.”