Employer Group Health Plans

Plans Take Wait-and-See Approach to Vendors Promising Help with Weight Loss Medication Costs

As the use of and interest in GLP-1 medications for weight loss increases, numerous vendors are pitching self-insured health plans on solutions to manage the demand and high costs of the medications. However, benefits experts say employers are approaching these outside companies with caution and are still trying to figure out how to manage the significant expenses associated with GLP-1 drugs.

Chantell Sell Reagan, Pharm.D., WTW’s national pharmacy clinical leader, estimates that about 25 to 30 vendors are marketing solutions to employers to help with FDA-approved weight loss medications such as Novo Nordisk’s Wegovy (semaglutide) and Eli Lilly & Co.’s Zepbound (tirzepatide). Wegovy and Zepbound are also approved to treat type 2 diabetes under the brand names Ozempic and Mounjaro, respectively.

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California’s 3% Health Care Spending Target Prompts Angst, Anxiety

California recently became the latest state to implement a limit on health care spending growth, with a new state agency targeting an increase of no greater than 3% by 2029. Commercial payers have largely backed the spending targets, but providers have argued that the targets aren’t reachable and Medicaid stakeholders — including the state’s largest managed care organization — are concerned that the target may curtail access for beneficiaries and harm the solvency of safety net providers.

The spending target was set by the board of the Office of Health Care Affordability (OHCA), which was established in 2022. The board’s membership was appointed by Gov. Gavin Newsom, a Democrat. The board set target spending growth rates of 3.5% in 2025 and 2026, 3.2% in 2027 and 2028, and 3.0% in 2029. OHCA will require payers regulated by the state and providers alike to meet the designated spending targets. Organizations that don't meet the spending targets will be subject to a state-overseen corrective action plan and possibly fines.

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HSA-Eligible Plans Have Mixed Impact on Health Care Use, No Impact on Spending

People with health savings account-eligible high-deductible health plans (HDHPs) use less outpatient services and fill fewer prescription medications than people with PPOs, but HSA plan enrollment appears to have no impact on total health care spending, according to a recent study published by the Employee Benefit Research Institute (EBRI).

As of 2022, 57.9% of employees were enrolled in an HSA-eligible health plan, while 32.3% of them were in an HDHP that was not associated with an HSA.

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Cigna Posts Strong First-Quarter Results Despite VillageMD Writedown

In its first quarter results, The Cigna Group’s low care utilization numbers and focus on stock repurchases garnered the commercial insurance giant positive reviews from Wall Street analysts — despite a net first-quarter loss that executives attributed that loss to a $1.8 billion writedown on Cigna’s VillageMD joint venture with Walgreens Boots Alliance Inc. Cigna also raised its full-year adjusted earnings per share (EPS) guidance by $0.15.

Cigna lost $277 million in the first quarter due to the VillageMD writedown, compared to a $1.2 billion profit in the first quarter of 2023. However, total revenue increased, with the firm taking in $57.2 billion for the first quarter, a year-over-year increase of over $10.7 billion. EPS for the first quarter of this year will be -$0.97. However, full-year EPS guidance increased to $28.40, in large part because Cigna posted a first-quarter medical loss ratio (MLR) of 79.9%, down 140 basis points year over year

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Analyst: Humana’s Low Share Price Could Draw Cigna Takeover Attempt

With Humana Inc.’s share price slumping in recent months, one Wall Street analyst points out that conditions may be better than ever for a possible takeover of the Medicare Advantage insurer by The Cigna Group.

“The math now works for a [Cigna] + [Humana] fusion even with [Humana’s] lower EPS [earnings per share],” wrote Jefferies analyst David Windley in an April 22 note to investors. The two managed care giants were rumored to be in talks to combine at the end of 2023, but the Wall Street Journal reported on Dec. 10 that the firms were walking away from the deal. But that was before Humana cut its full-year EPS outlook when reporting its fourth-quarter 2024 results earlier this year, citing a trend of higher-than-expected utilization that has bogged down the MA-focused carrier’s results since the beginning of 2023.

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UnitedHealth — Mostly — Calms Jittery Analysts With 1Q Earnings Report

Although UnitedHealth Group is facing a host of headwinds — including responding to a massive cyberattack and managing elevated care utilization — Wall Street analysts largely deemed its first-quarter earnings report on April 16 “better than feared,” albeit with a few asterisks.

The cyberattack in question started in February and targeted UnitedHealth’s Change Healthcare division. It significantly disrupted providers’ ability to file claims and receive reimbursement, spurring UnitedHealth to issue short-term loans to some affected providers and temporarily suspend prior authorization for certain services, among other remediation measures.

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Elevance Again Beats Utilization Blues, Launches Primary Care PE Deal

Elevance Health, Inc. posted solid results in the first quarter of 2024 and announced an agreement to build a new primary care-focused provider unit with financing from private equity firm Clayton, Dubilier and Rice LLC (CD&R). Wall Street analysts were positive about the results, praising the firm’s relatively low care utilization — an area where other health insurers have struggled in recent quarters.

Elevance has been busy with dealmaking in recent months. The CD&R deal, announced April 15, will see the private equity firm and Elevance combine what a CD&R press release termed “certain care delivery and enablement assets of Elevance Health’s Carelon Health and CD&R portfolio companies, apree health and Millennium Physician Group” into a “payer-agnostic” primary care provider focused on value-based contracting, including for patients covered by commercial insurance. It will serve 1 million patients from its inception.

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‘Not a Fluff Piece’: AHIP, AMA, NAACOS Offer Actionable Valued-Based Care Tips

Payers and providers are increasingly adopting value-based care, although they need to continue to invest in the models and collaborate to make them work, according to a report released on April 10 by AHIP, the American Medical Association (AMA) and the National Association of Accountable Care Organizations (NAACOS). The 74-page report identified best practices for developing payment arrangements for value-based care, including establishing clearly defined contract terms and considering ways to incentivize payers and providers to participate and move away from fee-for-service arrangements.

“Our goal here — AMA, AHIP and NAACOS — is to identify these real world best practices, get those in the hands of health plans, of physicians and clinicians and the teams in general, the VBC entities, so that they can really absorb this information [and] take action based on it related to their own participation in these models, so that we can really scale this nationwide,” Danielle Lloyd, AHIP’s senior vice president of private market innovations and quality initiatives, said during an April 12 panel discussion at the NAACOS Spring 2024 conference in Baltimore.

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Current Market Access to GLP-1s

In March, the FDA approved Novo Nordisk’s Wegovy (semaglutide) for cardiovascular risk reduction, which could further boost the already-strong sales for the GLP-1 weight-loss medication.

Specifically, Wegovy is now approved to reduce risk of “major adverse cardiovascular events (MACE) including cardiovascular death, non-fatal heart attack (myocardial infarction) or non-fatal stroke” in adults who are either overweight or obese and have established cardiovascular disease, per a Novo press release.

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Current Market Access to GLP-1s

In March, the FDA approved Novo Nordisk’s Wegovy (semaglutide) for cardiovascular risk reduction, which could further boost the already-strong sales for the GLP-1 weight-loss medication.

Specifically, Wegovy is now approved to reduce risk of “major adverse cardiovascular events (MACE) including cardiovascular death, non-fatal heart attack (myocardial infarction) or non-fatal stroke” in adults who are either overweight or obese and have established cardiovascular disease, per a Novo press release.

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© 2024 MMIT