Health Plan Weekly

  • In PBM-Related Lawsuits, Critics Could Discover ‘Ammunition’

    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.”

  • Long-Term Care Sector, in Crisis, Grapples With ‘Age-Friendly’ Approach

    The long-term care needs of the nation’s “silver tsunami” of 65-and-older population — a wave that began as the first of the baby boomer generation turned retirement age in 2011 — continue to elicit challenges in the broad health care buckets of spending, coverage, access to services and disparities in care. But during a recent webinar, experts discussed some promising solutions, including one health insurer’s initiative that takes a caregiver-centric approach to post-acute care.

    Such pervasive problems in long-term care, an industry with a $415 billion tab in annual spending, were the primary theme of an Aug. 7 National Institute for Health Care Management (NIHCM) webinar, an event that framed the contributory elements of the country’s “long-term care crisis” — namely, underinvestment, a lagging workforce, fragmented care and an industry that often fails to take a person-centered approach.

  • What’s Driving ACA Premium Increases in 2025?

    Affordable Care Act exchange insurers proposed a median premium increase of 7% in 2025, with most falling between a 0% and 10% increase, according to an analysis by Peterson-KFF Health System Tracker.

    Among the 324 ACA exchange insurers across 50 states and Washington, D.C., that were included in KFF’s analysis, proposed premium changes ranged from a drop of -14% to a jump of 51%. And while 50 of the health plans proposed decreasing premiums, 85 requested rate increases greater than 10%.

  • MCO Stock Performance, July 2024

    Here’s how major health insurers’ stock performed in July 2024. UnitedHealth Group had the highest closing stock price among major commercial insurers as of July 31, 2024, at $576.16. Humana Inc. had the highest closing stock price among major Medicare insurers at $361.61.
  • News Briefs: Centene Will Exit MA Market in Six States Next Year

    For the 2025 plan year, Centene Corp. will not offer Medicare Advantage plans in Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island and Vermont, Modern Healthcare reported, citing an Aug. 5 note from investment bank Stephens. However, Centene will continue offering Medicare Part D Prescription Drug Plans in those states. Pinnacle Financial Services, a health insurance brokerage, also posted to its website a notice from Centene about exiting those markets, which account for about 3% of the insurer’s MA membership.  

    BlueCross BlueShield of Vermont, the state’s largest insurer, is on the verge of insolvency, according to a July 29 article in the Burlington Free Press. However, Kevin Gaffney, commissioner of the state’s Department of Financial Regulation, told the newspaper, “BlueCross BlueShield of Vermont is a big tanker. We have to start to turn it. We can do that and there are steps to do it.” Gaffney said he is requiring the insurer to file a plan of solvency by early September. In October 2023, BCBS of Vermont finalized an “affiliation” with Blue Cross Blue Shield of Michigan in which the Vermont plan became a subsidiary of BCBS of Michigan.  

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