About health insurance/insurers
Cigna Resumes Merger Discussions with Humana After Talks Ended Last Year “The two health insurance giants, with a combined market value of more than $125 billion, have held informal discussions recently about a potential deal, said the people who asked to not be identified because the talks aren’t public. The discussions are in early stages, they added.
Shares of Humana were up 5.6% after the close of regular trading Friday, while Cigna fell about 5.3%…
Cigna is looking to close the sale of its Medicare Advantage business in the coming weeks before committing to any other transactions, one of the people said. That exit could help pave the way for a deal with Humana by removing areas of overlap that would draw scrutiny from antitrust regulators.”
Why Do Health Insurers Keep Getting Slammed With Higher Costs? “The surge in Medicaid costs may go beyond just a mismatch between reimbursement rates and patient health. As is already the case in Medicare, we could be seeing the start of a broader rise in healthcare expenses as more low-income Americans seek treatment for a variety of conditions, many worsened by the pandemic. For example, both UnitedHealth and Elevance have reported higher behavioral health costs in their Medicaid programs. It has been well documented that low-income Americans experience higher rates of mental-health issues, and the pandemic likely exacerbated this trend.”
Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care “On May 17, 2023, the Permanent Subcommittee on Investigations (“PSI” or “the Subcommittee”) launched an inquiry into the barriers facing seniors enrolled in Medicare Advantage in accessing care…
Among the Subcommittee’s new findings:
• Between 2019 and 2022, UnitedHealthcare, Humana, and CVS each denied prior authorization requests for post-acute care at far higher rates than they did for other types of care, resulting in diminished access to post-acute care for Medicare Advantage beneficiaries.
o In 2022, both UnitedHealthcare and CVS denied prior authorization requests for post- acute care at rates that were approximately three times higher than the companies’ overall denial rates for prior authorization requests. In that same year, Humana’s prior authorization denial rate for post-acute care was over 16 times higher than its overall rate of denial.
PSI also obtained internal documents that provide insight into each company’s use of the prior authorization, including the role of automation and predictive technologies.”
Comment: Read the entire summary and look at Figure 1 on page 19.
About pharma
The Powerful Companies Driving Local Drugstores Out of Business “Obscure but powerful health care middlemen — companies known as pharmacy benefit managers, or P.B.M.s — [have destroyed local pharmacy businesses].”
This has been happening all over the country, a New York Times investigation found. P.B.M.s, which employers and government programs hire to oversee prescription drug benefits, have been systematically underpaying small pharmacies, helping to drive hundreds out of business.
The pattern is benefiting the largest P.B.M.s, whose parent companies run their own competing pharmacies. When local drugstores fold, the benefit managers often scoop up their customers, according to dozens of patients and pharmacists.”
Biden's proposed rule change for over-the-counter birth control coverage “The Biden administration is proposing rules that would require insurers to cover the costs of over-the-counter contraceptives without a prescription.”
About the public’s health
Tobacco Product Use Among Middle and High School Students — National Youth Tobacco Survey, United States, 2024 “From 2023 to 2024, current (previous 30-day) use of any tobacco product declined among high school students from 12.6% to 10.1%, largely driven by the decline in high school e-cigarette use (from 10.0% to 7.8%). During 2024, e-cigarettes remained the most commonly used tobacco product among U.S. youths; nicotine pouches were the second most commonly used tobacco product.”
About health technology
Baxter aims to import 18K tons of product: 6 IV shortage updates “Baxter International is responding to critical IV supply shortages affecting patients after Hurricane Helene disrupted its North Cove manufacturing facility, which produces 60% of the U.S. IV fluid market's supply.
With the situation growing urgent, Baxter is importing 18,000 tons of essential products to alleviate these shortages by the end of the year, according to an Oct. 17 news release from the company.”