About health insurance/insurers
White House to require insurers pay for mental health the same as physical health “Health insurers will be required to cover mental health care and addiction services the same as any other condition under a highly anticipated final rule being released Monday by the Biden administration.
The move is part of the administration’s ongoing battle with health insurers, who officials say are skirting a 2008 law requiring plans that cover mental health and substance use care benefits do so at the same level as physical health care benefits.”
About pharma
Rite Aid emerges from bankruptcy with $2.5B in exit financing and a new CEO at the helm “Retail pharmacy chain Rite Aid has emerged out of bankruptcy after slashing about $2 billion from its debt, the company announced last week.
The company also added about $2.5 billion in exit financing to support the business going forward, Rite Aid said.”
Pharmacy Benefit Manager Market Concentration for Prescriptions Filled at US Retail Pharmacies “In 2023, all 3 payer markets for PBM services were highly concentrated, but concentration varied and was highest in Medicare Part D. While CVS Caremark held the dominant share in all 3 payer markets, each of the PBMs appeared focused on a different payer: Express Script’s largest share was in the commercial market, while Optum Rx’s and CVS Caremark’s were in Medicare Part D and Medicaid managed care, respectively. These findings underscore the importance of considering payer-specific concentration when evaluating PBMs’ anticompetitive practices, as the 3 top PBMs may be pursuing different market strategies. The dominance of a few large PBMs across all payers and a smaller PBM (SS&C Health) in Medicare Part D alone has important antitrust implications.”
New AMA analysis of consolidation in PBM markets “The American Medical Association (AMA) today published its new annual analysis (PDF) of pharmacy benefit manager (PBM) markets confirming low competition among these middlemen in the pharmaceutical supply chain and high vertical integration of PBMs with health insurance companies…
The analysis lists national-level shares of the 10 largest PBMs. It finds that:
—The four largest PBMs collectively have a 70% share of the national PBM market.
—CVS Health is the largest PBM (21.3% market share), followed by OptumRx (20.8%), Express Scripts (17.1%), and Prime Therapeutics (10.3%).
—At the local level, the average PBM market is highly concentrated according to federal antitrust guidelines.
—Eight-two percent of PDP region-level PBM markets are highly concentrated.
—This indicates that only a few PBMs supplied insurers with PBM services and suggests low competition among PBMs…
The analysis found significant vertical integration between insurers and PBMs.
—Nationally, insurers that are vertically integrated with a PBM covered 72% of people with a commercial or Medicare Part D PDP.
—The share of people covered by an insurer that is vertically integrated with a PBM is higher in the Medicare Part D market (77%) than the commercial PDP market (69%).
—At the PDP region level, an average of 70% of people are covered by an insurer that is vertically integrated with a PBM.
—There is wide variation across PDP regions, with some having little vertical integration between insurers and PBMs, while others are almost entirely vertically integrated.”
About the public’s health
Deloitte Analysis: 50% of US Women Skip or Delay Medical Care due to Cost, Access, or Negative Experiences “Key takeaways
Fifty percent of women surveyed report skipping or delaying medical care; women are 35% more likely to skip care than men.
Women surveyed are 50% more likely than men to skip care due to long wait times, and 31% more likely than men to skip care due to cost.
The top three types of care women skip due to cost are acute illness (e.g., cold or flu), preventive care, and care for women's health issues.
Women surveyed are twice as likely as men to miss medical appointments due to transportation issues.”