With policymakers and industry stakeholders increasingly focused on the cost savings opportunities tied to biosimilars, a new Health Affairs study sheds light on some of the factors that influence uptake of these near-copies of pricey biologic medications.

Among almost 200,000 commercial and Medicare Advantage enrollees who newly initiated one of seven biologic drugs with available biosimilar versions — filgrastim, bevacizumab, epoetin alfa, trastuzumab, pegfilgrastim, infliximab and rituximab — the share of people initiating a biosimilar increased from 1% in 2013 to 34% in 2022. Patients who were younger than 18 years were less likely to initiate a biosimilar than other age groups. Meanwhile, enrollees in commercial high-deductible health plans were more likely to use a biosimilar, compared with those in MA plans.

The summer of 2024 is shaping up to be a hotbed of M&A activity among health systems that operate Medicare Advantage plans. While the year kicked off with Point32Health, Inc.’s planned acquisition of Baystate Health’s Health New England, which serves about 12,000 MA members, a flurry of deals announced in recent weeks will further shake up the landscape.

Kaiser Permanente in June unveiled its second Risant Health deal just a few weeks after shoring up its purchase of Geisinger Health, a 10-hospital system that operates one of the largest insurers in Pennsylvania. This time, the MA stalwart set its sights on Cone Health, a system of four hospitals in North Carolina. The health system also operates Triad HealthCare Network, a physician-led ACO, and an MA plan.

Affordable Care Act exchange insurers proposed a median premium increase of 7% in 2025, with most falling between a 0% and 10% increase, according to an analysis by Peterson-KFF Health System Tracker.

Among the 324 ACA exchange insurers across 50 states and Washington, D.C., that were included in KFF’s analysis, proposed premium changes ranged from a drop of -14% to a jump of 51%. And while 50 of the health plans proposed decreasing premiums, 85 requested rate increases greater than 10%.

Here’s how major health insurers’ stock performed in July 2024. UnitedHealth Group had the highest closing stock price among major commercial insurers as of July 31, 2024, at $576.16. Humana Inc. had the highest closing stock price among major Medicare insurers at $361.61.

With policymakers and industry stakeholders increasingly focused on the cost savings opportunities tied to biosimilars, a new Health Affairs study sheds light on some of the factors that influence uptake of these near-copies of pricey biologic medications.

Among almost 200,000 commercial and Medicare Advantage enrollees who newly initiated one of seven biologic drugs with available biosimilar versions — filgrastim, bevacizumab, epoetin alfa, trastuzumab, pegfilgrastim, infliximab and rituximab — the share of people initiating a biosimilar increased from 1% in 2013 to 34% in 2022. Patients who were younger than 18 years were less likely to initiate a biosimilar than other age groups. Meanwhile, enrollees in commercial high-deductible health plans were more likely to use a biosimilar, compared with those in MA plans.

Participants in the Affordable Care Act risk adjustment program will pay a record $10.3 billion for the 2023 benefit year, according to CMS. CVS Health Corp.’s Aetna is estimated to owe the highest amount, while several not-for-profit Blue Cross Blue Shield plans are slated to receive significant payments.

The ACA’s risk adjustment program, launched in 2014, transfers funds from insurers that cover lower-risk enrollees to insurers that cover higher-cost and higher-risk populations in the individual and small group health insurance markets.

Of all privately insured markets, Medicare Advantage had the highest gross margins per member in 2023, reaching $1,982, according to a new analysis from KFF on insurers’ financial performance. Margins have been consistently higher in MA than other sectors over the past decade. KFF pointed out that while gross margins are generally one good indicator of financial performance, they do not necessarily mean higher profitability, as gross margins do not account for any administrative costs or tax liabilities. Researchers analyzed data compiled by Mark Farrah Associates based on information provided by insurers to the National Association of Insurance Commissioners.

The Medicare Advantage quality bonus program (QBP) can be a boon to insurers and an object of scorn to MA’s critics. With both MA enrollment and QBP payments to highly rated plans on the rise, concern about overpayments and access to high-quality plans is mounting. Seeking greater understanding of these issues, a new analysis of CMS data from the Urban Institute examined changes in Stars performance, MA plan demographics and QBP payments from 2015 to 2023. Researchers found that both Star Ratings and QBP payments per enrollee increased from 2015 to 2023, with total QBP payments reaching nearly $13 billion in 2023 compared to $3 billion in 2015. The analysis also found that plans that receive the most bonus payments are also more likely to enroll the most socioeconomically advantaged beneficiaries, raising questions about whether enhanced benefits are reaching the populations most in need of them.

States have been pursuing reforms that would limit hospitals’ ability to charge facility fees for routine medical services delivered in outpatient settings, which drive up enrollees’ premiums and out-of-pocket health care costs, according to a study by Georgetown University’s Center on Health Insurance Reforms.

Facility fees are charges from hospitals and other institutional health care providers that ostensibly cover their operational expenses for providing care. When hospitals acquire or affiliate with physician practices and other outpatient health care providers — a trend seen in the U.S. in recent years — ambulatory services provided at outpatient practices often generate a second bill for the facility fee on top of the professional fees the practitioners charge.

Beginning on July 18, Boehringer Ingelheim will offer its citrate-free Cyltezo (adalimumab-adbm), an interchangeable biosimilar to Humira (adalimumab), at a low cash price available exclusively on the GoodRx website, according to a press release. Both high- and low- concentration versions of the biosimilar, administered in either auto-injectors or pre-filled syringes, will be available at a price of $550 per two pack, a 92% discount from the Humira list price.

Following the launch of Amgen Inc.’s Amjevita (adalimumab-atto), another nine FDA-approved Humira biosimilars entered the U.S. market. Most recently, Teva Pharmaceuticals, a unit of Teva Pharmaceuticals Industries Ltd., and Alvotech launched Simlandi (adalimumab-ryvk) in May. The FDA approved the interchangeable, high-concentration, citrate-free drug in February for nine of its reference drug’s indications.