About health insurance/insurers
The Facts about Cigna Healthcare's Claims Review Process Cigna’s response to claims it uses algorithms to deny claims.
Medicare Advantage Supplemental Benefits Address Health-Related Social Needs A report from Elavance. See page 7 for a summary of findings. For example: “In 2022, the uptake of supplemental benefits among Elevance Health’s affiliated MA plan enrollees was strong. 83 percent of dual eligible individuals and 75 percent of non-dual eligible individuals used one or more of the available supplemental benefits during the calendar year.
Sixty-four percent of dual eligible individuals and 48 percent of non-dual eligible individuals used at least two different supplemental benefits.”
About hospitals and healthcare systems
HCA posts $2.6B net gain in 1st 6 months “Nashville, Tenn.-based HCA Healthcare, one of the largest for-profit health systems in the U.S., reported net income of $1.19 billion for the second quarter of 2023, 3.3 percent higher than the same period in 2022 ($1.155 billion), which included $110 million in losses on debt and asset sales.
The 182-hospital system raised its guidance for the year to a net income of up to $5.255 billion from previous estimates of up to $5.16 billion. HCA also raised its revenue guidance to up to $64.75 billion for the year compared with $64.5 billion.”
UHS finance chief said company favors patients whose insurance pays more “The country’s largest private psychiatric hospital operator cherry-picks patients whose insurance will pay more, its finance chief said on an earnings call Wednesday.
It’s no secret that such hospitals, especially when run by for-profit companies, base admission decisions on how much they’ll get paid, but it’s rare to hear the practice described so bluntly. The comments came from Steve Filton, the chief financial officer of investor-owned Universal Health Services, a company that runs more than 300 behavioral health hospitals nationwide that handled just shy of 120,000 admissions in the three months that ended June 30.”
About pharma
Facing potential $10B trial loss, Teva seeks appeal of recent ruling in kickbacks case “In the case, the U.S. alleges that Teva paid two patient foundations, the Chronic Disease Fund and The Assistance Fund, more than $350 million between December 2006 and January 2017. Those payments directly covered Medicare co-pay obligations for patients on Copaxone, the government argues. At the same time, the company raised the price of Copaxone five-fold.
Lawyers for the U.S. say Teva ‘conspired’ with a specialty pharmacy and used the foundations ‘as conduits to subsidize Medicare co-pays’ for its star drug. As the Department of Justice has noted, the Anti-Kickback Statute (AKS) prohibits pharma companies from paying Medicare co-pays so that market forces remain in place, and so there isn't an undue inducement for patients to receive a specific drug.”
GLP-1 drugs are still in demand. Insurers are cutting back coverage in response, Found study shows “As demand surges for GLP-1 therapies, insurers are pulling back on coverage, according to new data from obesity care provider Found.
The company analyzed GLP-1 benefits and access for its patient population and found that currently 69% do not have coverage for this class of drugs to treat diabetes or for weight loss, a significant decline in coverage in the past seven months. The findings, which were provided exclusively to Fierce Healthcare, track with national trends in coverage for these products, the Found team said.
Coverage for GLP-1 drugs has decreased by 50% since December 2022, according to the analysis. Nearly 70% of insurance plans included in the study did not indicate coverage for GLP-1s either for obesity or diabetes treatment.”
About the public’s health
US Officials Weigh Deeming a Syphilis Emergency as Drugs Run Low “A shortage of penicillin to treat a skyrocketing number of syphilis cases is so dire that US health officials are debating the need to declare a public health emergency, according to people familiar with the matter.
Major US medical centers are rationing the recommended treatment for the deadly sexually transmitted disease because of a supply crunch. From Michigan to Missouri to Texas, some health-care providers are prioritizing giving a key treatment — penicillin G benzathine — to pregnant patients and babies, because the drug can pass through the placenta and also treat the fetus.”
About healthcare IT
Cost of a Data Breach Report 2023 Annual IBM report. “The average cost of a data breach reached an all-time high in 2023 of USD 4.45 million. This represents a 2.3% increase from the 2022 cost of USD 4.35 million. Taking a long-term view, the average cost has increased 15.3% from USD 3.86 million in the 2020 report….
Healthcare continues to experience the highest data breach costs of all industries, increasing from USD 10.10 million in 2022 to USD 10.93 million in 2023—an increase of 8.2%. Over the past three years, the average cost of a data breach in healthcare has grown 53.3%, increasing more than USD 3 million compared to the average cost of USD 7.13 million in 2020. Healthcare faces high levels of industry regulation and is considered critical infrastructure by the US government. Since the start of the COVID-19 pandemic, the industry has seen notably higher average data breach costs.”
US FTC settles with health information firm Surescripts over antitrust lawsuit “The U.S. Federal Trade Commission on Thursday said it settled with Surescripts over a lawsuit accusing the health information technology firm of using illegal methods to maintain monopolies over two parts of the electronic prescriptions market.
The settlement will prohibit Surescripts "from engaging in exclusionary conduct and executing or enforcing non-compete agreements with current and former employees," the FTC said in a statement.
The FTC in its 2019 lawsuit had accused Surescripts, which provides electronic records and prescription services to doctors, pharmacists and patients, of requiring long-term exclusivity from customers and punishing them with high prices if they bought some prescriptions from another company.”
About healthcare finance
From Reuters: Forecasts from HCA, Bristol Myers, Labcorp, Edwards Lifesciences and AbbVie.
Quest Diagnostics and Takeda beat profit estimates.