Health Plan Weekly

The cost of providing health benefits to employees grew more than was projected in 2023 and is expected to rise by an eye-popping rate of 7.8% by 2025, according to an annual survey of large companies from the Business Group on Health. And to address those rising costs, employers are demanding greater accountability from their health plans, PBMs and other vendors. 

“Health care costs is really the headline story of this year’s findings,” Ellen Kelsay, Business Group on Health president and CEO, said during an Aug. 20 virtual press briefing. Health care trend — or the rise in spending — was 6.8% in 2023, which was up from 4.6% in 2022 and greater than the 5.9% estimated trend. 

With both the Republican and Democratic conventions now finished and a little over two months until the U.S. presidential election, speculation over how nominees Kamala Harris or Donald Trump would influence health policy is beginning to heat up. To that end, Harris’ recent release of her economic policy outline has offered more clues about her highest priorities — while one former Trump administration official says he expects Republicans to largely avoid health care issues during the campaign. 

“Just to be very clear, I think on the Republican side, you’re still not going to see much emphasis on health care,” Alex Azar, who was secretary of HHS under Trump, said during an Aug. 14 webinar hosted by Avalere Health. “President Trump is known to not just read from a teleprompter, so who knows,” he added, but it’s more likely that issues like inflation and immigration will be in the spotlight. 

In 2023, the federal government received more than three times as many surprise billing payment disputes it received in 2022, and provider groups continued to win the vast majority of cases while reaping higher payment amounts, according to new CMS data.

The No Surprises Act (NSA), passed in 2021, banned the practice of billing patients for the difference between what their insurer pays and what a provider charges when patients unknowingly receive care from an out-of-network provider. The law also established a Federal Independent Dispute Resolution (IDR) process that out-of-network providers and insurers can use to determine the OON rate that providers should receive if the two parties fail in their own attempts to negotiate.

When CMS on Aug. 15 revealed the prices of the 10 drugs subject to Medicare price negotiation, its much-anticipated disclosure still left many questions unanswered. In the managed care world, the biggest question mark remains how Medicare Part D plans will adjust their formularies in reaction to the new government-set prices — but one industry expert says it will be a while before more clarity emerges. 

“These prices are effective Jan. 1, 2026, so they should not, in theory, impact the 2025 formularies,” which have been largely decided since April, says Jennifer Snow, founder of the health policy and reimbursement consulting firm Apteka LLC.