Most U.S. voters are unaware of the Medicare drug pricing provisions resulting from the Inflation Reduction Act, although awareness among older voters has improved since November. That’s according to a new KFF poll tracking voters’ perceptions of major health and entitlement programs and how they align with presidential candidates’ views. Of voters aged 65 and older, nearly half (48%) indicated awareness of drug price negotiation — compared with 36% in November — and 40% knew about the annual limit on Part D out-of-pocket prescription drug costs, up from 27% in November. Meanwhile, large shares of voters indicated support for extending some of the prescription drug provisions to all adults with private insurance, which President Joe Biden has proposed, reported KFF.

A group of lawmakers is urging federal regulators to investigate UnitedHealth executives’ sale of company stock right after learning that the health care firm was the target of a Dept. of Justice (DOJ) investigation concerning its provider-acquisition spree. As for the investigation itself, one antitrust lawyer says it could take years before the DOJ files a case — but if it does, regulators could try to force the health care giant to spin off all or part of its Optum division.

Meanwhile, the DOJ’s antitrust division on May 9 announced a new Task Force on Health Care Monopolies and Collusion, which it said will “guide the division’s enforcement strategy and policy approach in health care, including by facilitating policy advocacy, investigations and, where warranted, civil and criminal enforcement in health care markets.” Some of the competition concerns the task force will examine include “issues regarding payer-provider consolidation” and “serial acquisitions.”

Some insurers and retailers are backing away from their investments in provider verticals, especially retail health brands. Cigna's stake in VillageMD, a joint venture with Walgreens Boots Alliance Inc., has lost money, and VillageMD will soon close many locations instead of pursuing aggressive growth. Walmart Inc. also said it will close its health care venture.

In recent years, diversified insurers have seen clinics in which they own a stake as a place where they can control cost of care and, ideally, improve member satisfaction by reducing the friction required to access basic care services — in addition to growing revenue in a segment that isn’t capped by medical loss ratio (MLR) rules. But that premise hasn’t always amounted to much more than a compelling story in practice.

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

Testifying before the U.S. House Committee on Energy and Commerce, HHS Inspector General Christi Grimm identified Medicare Advantage risk adjustment and durable medical equipment as two areas at risk for fraud and improper payments. The current MA payment structure, which adjusts payments based on the relative health of beneficiaries, “creates an incentive for managed care plans to make patients appear sicker simply to claim payments to which they are not entitled,” she told representatives during the April 16 hearing. She noted that OIG identified MA overpayments across 33 audits totaling more than $500 million, an amount that “is likely just the tip of an iceberg.” She said these issues raise questions about the accuracy of the data and whether patients are receiving needed treatment. In addition, OIG’s work looking at Medicaid managed care demonstrates that “states need better, more useful data that would ensure states are not paying for deceased enrollees or paying for an enrollee who has moved to another state,” she said. OIG is “struggling to keep up” with the pace of the growing health care industry and is “declining 300 to 400 viable fraud cases per year because we don’t have the agents to work them,” she added.

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.

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.

The Kroger Company recently revealed that it had entered into a definitive agreement to sell Kroger Specialty Pharmacy to CarelonRx, a subsidiary of Elevance Health, Inc, formerly known as Anthem, Inc. The deal, say industry experts, allows Kroger to focus on retail pharmacy while bringing scale and coveted limited-distribution contracts to CarelonRx as it seeks to establish a stronger footing within the specialty space.

Unveiled March 18, the deal is expected to close in the second half of this year. It does not include Kroger’s in-store retail pharmacies and The Little Clinics. CarelonRx, formerly known as IngenioRx, operates within Carelon, Elevance’s health care services brand that serves one in three people across 50 states.

Elevance Health Inc. plans to buy Kroger Co.’s specialty pharmacy division, the firms revealed on March 18, in a deal that closely follows Elevance’s purchase off Paragon Healthcare, Inc., an infusion center provider. Health care insiders say that the Kroger deal is a shrewd play for Elevance, which in recent years has sought to expand its Carelon health services arm, particularly the CarelonRx PBM.

The deal could help Elevance catch up with other major insurers. Elevance, a for-profit Blue Cross and Blue Shield affiliate, lags behind its publicly traded managed care competitors, such as The Cigna Group, CVS Health Corp. and UnitedHealth Group, in health services revenue. All three health services divisions, respectively Evernorth, Caremark and Optum, include a major PBM and lucrative specialty pharmacy divisions that serve both their own plans and payers outside their own enterprise. Cigna and CVS's care management divisions had higher revenues and earnings than their insurance divisions in the fourth quarter of 2023, which is often the case for those firms.

Since 2021, just three consumer operated and oriented plans (CO-OPs) have remained operational out of the original 23 nonprofit insurers created by the Affordable Care Act. Now, one of the three survivors — Common Ground Healthcare Cooperative (CGHC) — is poised to shed its CO-OP identity and combine forces with CareSource, a Medicaid-focused insurer based in Ohio.

In a Feb. 27 press release, CGHC said it was “financially healthy and on track to repay” all loans that it’s received from the federal government.

“Even so, it’s challenging as a nonprofit startup to support necessary investments in operations and diversification while keeping premiums affordable for our members,” CEO Cathy Mahaffey said.