Health Plan Weekly
-
Medicare-Medicaid Enrollees Increasingly Choose Medicare Advantage Plans
The number of dual eligible beneficiaries — people who are enrolled in both Medicare and Medicaid coverage — increased from 10.4 million in 2016 to 12.8 million in 2024. And a growing share of them chose a private Medicare Advantage plan rather than a traditional fee-for-service Medicare plan, according to a recent analysis from The Commonwealth Fund.
Dual eligible enrollees typically require more intensive and costly health care than the average Medicare enrollee. To qualify as a dual enrollee, a person must be at least 65 years old or have a qualifying disability or medical condition, have a low income and limited resources. Between 2013 and 2021, the percentage of dual eligible beneficiaries covered by a MA plan more than doubled, from 24% to 51%.
-
MCO Stock Performance, June 2024
Here’s how major health insurers’ stock performed in June 2024. Elevance Health, Inc. had the highest closing stock price among major commercial insurers as of June 28, 2024, at $541.86. Humana Inc. had the highest closing stock price among major Medicare insurers at $373.65.
-
News Briefs: Vermont Sues PBMs Over Formulary Exclusions
Another state attorney general, Vermont Democrat Charity Clark, has filed a lawsuit against prominent PBMs — in this case, The Cigna Group’s Evernorth and CVS Health Corp.’s Caremark. According to a July 17 press release from Clark’s office, the two PBMs “control approximately 95% of the commercial market in the state” and “as a result, they have a hand in nearly every prescription transaction and have near complete control over the pricing, dispensing, and reimbursement systems.” The press release alleges that the two PBMs “grant placement on their standard formularies to the prescription drugs with the largest payments from manufacturers and the highest list prices, while excluding lower-cost prescription drugs.” Arkansas Republican Attorney general Tim Griffin recently sued UnitedHealth Group’s Optum Rx and Evernorth over their alleged roles in the opioid epidemic. And in 2023, Ohio Attorney General Dave Yost filed a lawsuit accusing Express Scripts, Prime Therapeutics, Humana Pharmacy Solutions and Ascent Health Services of colluding to drive up drug prices.
-
Experts Challenge Specter of ‘Widespread’ ACA Enrollment Fraud
In recent letters to two federal watchdog agencies, Republican leaders of key House committees demand an investigation into “widespread” improper enrollment in Affordable Care Act exchange plans, citing the findings of a paper from Paragon Health Institute, a right-leaning think tank.
Health policy experts who spoke to AIS Health agree that that there are incentives for enrollees — and the brokers who help them find coverage — to estimate their income in such a way that they will qualify for the richest ACA subsidies. However, they aren’t convinced that there’s large-scale enrollment fraud taking place.
In their paper, the Paragon researchers estimate that 4 million to 5 million people are improperly enrolled in $0-premium (or fully subsidized) ACA exchange plans as of 2024, costing taxpayers between $15 billion and $20 billion.
-
FTC’s Reported Plan to Sue PBMs Over Rebates Raises Eyebrows
The Federal Trade Commission (FTC) on July 9 released a new report stemming from its investigation into the business practices of PBMs — and on the next day, the Wall Street Journal and other news outlets reported the antitrust agency is on the verge of filing a lawsuit against the country’s largest PBMs over their business practices related to the rebates they negotiate with drug manufacturers for products including insulin. The FTC reportedly is concerned that the lure of high rebates is causing PBMs to steer patients toward higher-cost drugs.
The FTC has not yet confirmed the WSJ report, which cited people familiar with the matter. But one expert says that the FTC needs to be careful about the way it treats rebates.
The Latest
