What's Going on in Healthcare

What's New in Healthcare

$5 Ozempic? New study sparks calls for Novo Nordisk to cut prices

March 28th, 2024  Beckers Hospital Review          

While the list price for a monthly supply of Ozempic in the U.S. nears $1,000, new research indicates it could be manufactured for less than $5 per month, sparking calls from lawmakers for Novo Nordisk to lower the price of its blockbuster diabetes and weight loss drug.  Read More

73% of workers would jump ship for better family benefits

March 26th, 2024  BenefitsPro         

Nearly three quarters of employees would leave their jobs for better family benefits. Americans are unhappy about their benefits. A report, “Future of Family Friendly 2024: Benefits That Mater,” from Ovia Health by Labcorp reveals nearly three quarters of employees would leave their jobs for better family benefits.  Read More

Workers want more health benefit options, employers concerned about cost, survey finds

March 20th, 2024  BenefitsPro         

Forty-two percent of employees said they would rather receive better health insurance than a raise this year. Read More

The '3rd generation' of weight loss drugs

March 18th, 2024  Beckers Hospital Review        

Anita Courcoulas, MD, defines GLP-1s as “generation one;” dual GLP-1 and GIPs as the second; and a triple threat of GLP-1, GIP and GCGRs as the third generation of weight loss drugs.  Read More

Zepbound surpasses Wegovy in new prescriptions: Reuters

March 18th, 2024  Beckers Hospital Review        

First-time prescriptions for Eli Lilly’s Zepbound surpassed those for Novo Nordisk’s Wegovy in early March, according to data cited by Reuters.  Read More

Hidden crisis: Millions with employer insurance delay care due to high costs

March 15th, 2024  BenefitsPro        

One in six respondents reported that their work was affected by a health issue they couldn’t afford to treat. Read More

FAQs on Prescription Drug Importation

March 11th, 2024  Kaiser Family Foundation       

The high cost of prescription drugs continues to be a top health care priority for the public. Policymakers from both parties at the federal and state level have been pursuing a range of options to lower drug prices for Americans, one of which would allow for the safe importation of prescription drugs from Canada. This idea is based on data showing that people in the U.S. often pay more for medications than people in other countries. Read More

A 'paradigm shift' in weight loss drug coverage

March 11th, 2024  Beckers Payer       

Wegovy is now approved to be used to reduce the risk of heart attack, stroke and cardiovascular death, which could lead to broader payer coverage of the drug.  Read More

UnitedHealth faces proposed class-action suit over Change Healthcare data breach

March 6th, 2024  Beckers Payer       

UnitedHealth Group and its Change Healthcare business are facing a proposed class-action lawsuit in the wake of a cyberattack that downed Change’s applications, complicating operations at hospitals, physician practices and pharmacies.  Read More

Biden Is Right. The US Generally Pays Double That of Other Countries for Rx Drugs.

March 6th, 2024  Kaiser Family Foundation        

If you went “anywhere in the world,” you could get a prescription filled for 40% to 60% less than it costs in the U.S.  Read More

Consumer agency's new focus on barring medical debt on credit reports

March 5th, 2024  BenefitsPro       

The Consumer Financial Protection Bureau’s Director Rohit Chopra is making a sweeping change to address medical debt that now touches some 100 million Americans, and the new rules are expected to be unveiled later this year.  Read More

Even with employer-sponsored health insurance, 43% struggle with medical debt

March 1st, 2024  BenefitsPro       

Almost 4 in 10 at some point have been unable to afford rent, groceries or utilities because of medical bills.  Read More

Employers should expect higher health care costs in 2024, outpacing inflation

February 29th, 2024  BenefitsPro       

Higher medical costs for employer-sponsored plans are due to advances in treatments and health care consolidation trends, as well as specialty drug use and the new GLP-1 class of weight loss drugs, says a new report. Read More

Hospital expenses per inpatient day across 50 states

February 28th, 2024  Beckers Hospital Review      

Below are the adjusted expenses for nonprofit, for-profit and government hospitals per inpatient day in 2022 in every U.S. state, according to the latest estimates provided by Kaiser State Health Facts.  Read More

Rosen hotel magnate aims to disrupt health care: "Millions are getting screwed"

February 27th, 2024  Benefits Pro       

“While the nation is crippled with health care debt, while employers are spending more and more every single year, the reality is that revenue turns into profit for insurers,” Lester Morales said. Read More

A weight loss drug candidate could rival Ozempic

February 27th, 2024  Beckers Hospital Review       

Viking Therapeutics reported Feb. 27 strong results from a phase 2 trial of a new drug that could rival other GLP-1 medications like Ozempic, Mounjaro and Wegovy. Read More

U.S. pharmacies crippled by cyberattack at UnitedHealth's Change Healthcare

February 23rd, 2024 Benefits Pro        

Pharmacies are still grappling with difficulties providing prescriptions Friday following a cyberattack against one of the nation’s largest health-care technology companies that began on Wednesday. Read More

Health Care Costs Top the Public’s List of Financial Worries, and Those Who Are Struggling the Most Want to Hear Presidential Candidates Discuss Economic and Health Care Issues

February 21st, 2024  Kaiser Family Foundation      

At a time when kitchen table economic problems are on voters’ minds, unexpected medical bills and health care costs top the public’s list of financial concerns, and voters who are struggling to pay their monthly bills are the most eager to hear the presidential candidates talk about economic and health care issues, the latest KFF Health Tracking Poll finds. Read More

Most Americans don’t know how much their health care costs

February 9th, 2024  BenefitsPRO     

Only about 3 in 10 believe the quality of care and services they receive reflect their costs. Read More

How one company managed to cut its health spending by almost half

February 8th, 2024  BenefitsPRO     

In an era of rising health costs, it almost sounds too good to be true: A midsized Montana-based company managed to nearly halve its per-person health spending in just five years, without dropping benefits.  Read More

Drug costs are 3X in the U.S. what other countries pay, study finds

January 24th, 2024  BenefitsPRO     

Industry observers said that drug companies are likely to continue to oppose the government’s efforts to reduce prices. Read More

How does health spending in the U.S. compare to other countries?

January 23rd, 2024  Kaiser Family Foundation      

In this chart collection, we examine how U.S. health spending compares to health spending in other OECD countries that are similarly large and wealthy, based on median GDP and median GDP per capita. For this analysis, we reviewed the OECD Health Statistics database.  Read More

Employers are struggling to figure out if they're overpaying for health care

January 18th, 2024  Axios     

Employers are facing stronger legal requirements to ensure they aren’t wasting their workers’ money on overpriced health insurance, at the growing risk of financial consequences.  Read More

The high cost of weight-loss drugs is threatening coverage altogether

January 16th, 2024  BenefitsPRO     

With the price of GLP-1s reaching well over $1000 a month, local officials are warning that rising costs threaten to quickly drain government spending accounts.  Read More

UnitedHealth Group posts $5.5B profit in fourth quarter

January 12th, 2024  BenefitsPRO     

UnitedHealth Group recorded double-digit growth in revenue year over year across its core lines of business at UnitedHealthcare and Optum, according to the company’s fourth quarter earnings report released Jan. 12. Read More

Mark Cuban: CEOs 'waste a sh-tload of money' on healthcare

January 4th, 2024  Beckershospitalreview.com    

Billionaire entrepreneur Mark Cuban has made substantial progress in the healthcare and pharmacy space in nearly four years, and he’s learned a lot about its costs for employers and workers in that time, too. Read More

Eli Lilly to sell weight loss drugs directly to consumers; warns against 'cosmetic' usage

January 4th, 2024  Beckershospitalreview.com    

Eli Lilly has launched a new website for customers with migraines, obesity and diabetes to order prescription drugs directly from the manufacturer, including weight loss medications such as Zepbound Read More

New payer price transparency rules take effect in 2024

January 2nd, 2024 Beckerspayer.com   

New requirements for payers under CMS’ Transparency in Coverage rule took effect Jan. 1. Since July 1, 2022, payers have been required to disclose in-network provider rates for covered items and services; out-of-network allowed amounts and billed charges for all covered items and services; and negotiated rates and historical net prices for covered prescription drugs administered by providers. Read More

3 thing to know about specialty pharmacy in 2024

December 26th, BenefitsPRO   

Specialty drug costs keep going up for plan sponsors Here are a few considerations employers and their brokers and consultants need to take into account in the coming years.  Read More

Dangerous doctors? Malpractice-prone docs, hired by insurers, are 'cranking out denials'

December 26th, BenefitsPRO   

At least a dozen doctors were hired by major insurance companies after being disciplined by state medical boards or making multiple or outsized malpractice payments, according to a ProPublica and Capitol Forum investigation.  Read More

UnitedHealth, OptumRx sued by independent pharmacy over ‘unconscionable’ fees

December 20th, Healthcare Dive  

UnitedHealth and its pharmacy benefit manager OptumRx are being sued by an independent pharmacy for allegedly strong-arming pharmacies into agreeing to “unconscionable” performance-based fees, threatening their financial health. Read More

Americans less satisfied with almost every part of the health system

December 19th, Axios    

Americans’ satisfaction with almost every major part of the health care system has dropped since 2010, according to a new Gallup analysis. Driving the news: Drugmakers took the biggest reputational hit, and ratings for physicians fell sharply, too.  Read More

Drugmakers spend millions on campaign to gain support of U.S. physicians for weight loss drugs

December 15th, BenefitsPRO   

Pharmaceutical payments to physicians have long raised questions of ethics and influence, but such payments are legal in the U.S. Read More

The U.S. spent $4.5T on health care in 2022 (that’s $13,500 per person)

December 15th, BenefitsPro   

The health care spending growth in the United States may be settling back into pre-pandemic levels, while the insured consumers reached a historic high, according to the Centers for Medicare & Medicaid Services. Read More

US diabetes patients face delays as insurers tighten Ozempic coverage

December 12th, Reuters   

Some patients with type 2 diabetes say they are having more difficulty getting reimbursed for drugs like Ozempic as U.S. insurers implement restrictions designed to deter doctors from prescribing the medication for weight loss. Read More

House passes the Lower Costs, More Transparency Act

December 12th, Becker’s Hospital Review  

On the evening of Dec. 11, the U.S. House voted in favor of moving The Lower Costs, More Transparency Act forward. Read More

The realities of employer coverage for weight-loss drugs

December 7th, BenefitsPro   

For some employers, certain benefits of increasing coverage for obesity medication outweigh the cons of a high price tag. Read More

Adherence to Wegovy far outpaces older weight loss drugs: Cleveland Clinic study

December 6th, Becker’s Hospital Review  

Patients taking Novo Nordisk’s weight loss drug Wegovy in 2021 and 2022 were three times more likely to continue taking the medication a year later compared to older weight loss therapies, according to a study published Dec. 6 in Obesity.  Read More

Eli Lilly obesity drug hits pharmacy shelves

December 6th, Becker’s Hospital Review  

Zepbound, a newly approved obesity drug from Eli Lilly, hit the market Dec. 5.  Zepbound is a weekly injection for chronic weight management. The medication is available in six doses through prescriptions that can be filled by retail or mail-order pharmacies, Eli Lilly said in a Dec. 5 news release.   Read More

High cost of health care making consumers sick – in a literal way

November 30th, BenefitsPro 

The affordability of medical bills is shifting for credit-challenged Americans, with 44% who have a credit score of 669 or lower saying their deductible is not affordable.  Read More

BJC, Saint Luke's move forward with 28-hospital merger

November 29th, Beckers Hospital Review 

St. Louis-based BJC Healthcare and Kansas City, Mo.-based Saint Luke’s Health System — which signed a  letter of intent to combine in May — have satisfied all regulatory reviews and reached a definitive agreement to merge.   Read More

Grappling with weight loss drug coverage? Options to help employers control costs

November 28th, BenefitsPro  

Instead of jumping to GLP-1 drugs that can be costly, a step therapy approach guides patients by offering individualized care with behavioral changes, followed by mental health support and Gen 1 anti-obesity meds.  Read More

Why such ‘high markups’? Senators seek drug price probe of insurers who own PBMs

November 28th, BenefitsPro  

Sens. Elizabeth Warren and Mike Braun wrote a letter to HHS last week to investigate high drug prices – and any role played by health insurers’ shared ownership with the pharmacies that often fill the prescriptions.   Read More

Boom in weight-loss drugs to drive up US employers' medical costs in 2024

November 17th, Mercer/Reuters

Booming demand for newer weight-loss and diabetes drugs is expected to accelerate the rise in medical expenses for employers in the United States next year, staff health benefits consultant Mercer said on Friday.  Read More

Why unnecessary medical testing prevails in the U.S. health care system, wasting billions

November 13th, BenefitsPro 

Of the $3 trillion spent each year on health care in the U.S., 10% to 30% consists of so-called “low-value care” – when doctors order unnecessary X-rays, EKGs, lab tests and antibiotics, according to multiple estimates.  Read More

Why benefits consultants believe integrated health care navigation can reshape health care

November 6th, BenefitsPro 

Faced with tough decisions and trade-offs, employers are leaning more than ever on benefits consultants for trusted advice to help them manage the myriad choices available and plot a strategic course for their employee health care benefits.  Read More

Benchmark Survey: Annual Family Premiums for Employer Coverage Rise 7% to Nearly $24,000 in 2023; Workers Contribute $6,575 on Average Now, But Potentially More Soon

November 12th, Kaiser Family Foundation

Amid rising inflation, annual family premiums for employer-sponsored health insurance climbed 7% on average this year to reach $23,968, a sharp departure from virtually no growth in premiums last year, the 2023 benchmark KFF Employer Health Benefits Survey finds.  Read More

PBM reform is on, as Senate advances new bill that forces pharmacies to report costs

November 10th, BenefitsPro

The comprehensive new bill, which advanced on Wednesday, would introduce more transparency, such as requiring pharmacies to report medication costs – and would be paired with another PBM bill that passed earlier this year.  Read More

FDA approves Eli Lilly’s new weight loss drug Zepbound, cheaper than Wegovy

November 9th, BenefitsPro

Tirzepatide, the active ingredient in Lilly’s new drug, is already approved under the trade name Mounjaro, a diabetes drug, but Zepbound will list for a lower pre-insurance price than Novo Nordisk’s weight loss drug, Wegovy.  Read More

Medical debt is dropping from credit reports (but patients still being sued for unpaid bills)

November 8th, BenefitsPro

Under pressure from patient advocates and government regulators, credit agencies have taken steps to remove some medical debts from credit reports, but this could be costing physicians nationwide potentially billions of dollars. Read More

Primary care disrupted: Now, smaller employers are opening onsite clinics

November 2nd, BenefitsPro

In recent years, a modest number of small- and medium-size employers have set up their own health clinics to fill employees’ primary care needs at or near their workplaces – something large employers have done for decades. Read More

More Americans downgrading insurance plans to cope with rising costs

October 26th, BenefitsPro

The survey found more than half of Americans could not pay off an unexpected $5,000 health care out-of-pocket expense. Read More

Hospitals pushing back on price transparency fines

October 25th, Becker’s Hospital Review

Half of the hospitals that have been fined by CMS for alleged price transparency violations have appealed their penalties.  Read More

How does the quality of the U.S. health system compare to other countries?

October 23rd, Peterson-KFF Health System Tracker

Despite spending more money per capita on healthcare than any similarly large and wealthy nation, the United States has a lower life expectancy than peer nations and has seen worsening health outcomes since the onset of the COVID-19 pandemic.   Read More

Primary care doctors: The ‘quarterbacks’ in a value-based care playbook

October 17th, BenefitsPro

When doctors encourage informed referrals to specialists who can demonstrate lower costs and better outcomes, this can have a significant impact on VBC program costs, sometimes resulting in millions of dollars of annual savings. Read More

Hot self-funding takes from SIIA's 2023 National Conference

October 12th, BenefitsPro

Speakers at SIIA’s recent national conference in Phoenix had a lot to say about self-funding strategies, the Gag Clause Prohibition, artificial intelligence and the future of employee benefits and health care. Read More

Hawaii accuses top pharmacy benefit managers of illegally driving up prices

October 5th, Reuters

Hawaii has filed a lawsuit accusing the three largest U.S. pharmacy benefit managers of driving up brand-name prescription drug prices through a complex system of rebates and fees, joining other states that have brought similar claims against the drug industry middlemen. Read More

Stop-loss premiums increased 16% from 2021 to 2023, survey finds

October 3rd, BenefitsPRO   

Aggregate stop-loss coverage is most prevalent in conjunction with individual stop-loss deductibles of $250,000 or less. Read More

Will new Senate bill curb the power of the PBMs - and drive down drug costs?

September 29th, BenefitsPRO   

The Senate Finance Committee, which has jurisdiction over Medicare, introduced a bipartisan bill on Thursday – the latest move by Congress to rein in pharmacy benefit managers by creating independent audit efforts.  Read More

$26B Senate bill aims to solve the ‘crisis in primary health care’ by adding doctors, nurses

September 26th, BenefitsPRO   

Senate Health, Education, Labor and Pensions Chairman Bernie Sanders has announced that a new primary care bill has advanced in committee, which will increase funding for several key health care programs in rural areas. Read More

Federal bureau unveils proposals to remove medical debt from credit reports

September 22nd, Beckers Hospital Review  

The Consumer Finance Protection Bureau on Sept. 21 outlined proposals aiming to end “coercive debt collection tactics, clean up inaccurate data, and improve credit score predictiveness.”  Read More

US employers to see biggest healthcare cost jump in a decade in 2024

September 21st, Reuters  

U.S. employers are bracing for the largest increase in health insurance costs in a decade next year, according forecasts from healthcare consultants, but workers may be somewhat spared this time around in a tight labor market. Read More

Common procedures can double in cost when performed at a Hospital Outpatient facility vs. Ambulatory Surgery Center, BCBS data shows

September 14th, Beckerspayer.com  

Common medical procedures can cost more than twice as much when they take place in a hospital outpatient setting compared to a physician office or ambulatory surgery center, according to an analysis published Sept. 14 by the Blue Cross Blue Shield Association. Read More

House introduces bill focused on health care price transparency, PBMs and spread pricing

September 12th, BenefitsPRO 

Three House committees have introduced the Lower Costs, More Transparency Act, which would require hospitals, payers, labs, imaging providers and surgical centers to use machine-readable files to list prices they’ll charge patients Read More

Ozempic, Wegovy enter trials for treating addiction, dementia

September 7th, Beckers Hospital Review 

Researchers in the U.S. and U.K. are testing Type 2 diabetes drug Ozempic and weight loss therapy Wegovy for their potential in diminishing dementia and addiction, CNBC reported Sept. 7. Read More

Primary care docs affiliated with health systems drove up spending: study

September 5th, Axios

Primary care physicians affiliated with large health systems drive up spending on patient care through increased referrals to specialists, emergency department visits and hospitalizations, per a study led by the Harvard T.H. Chan School of Public Health. Read More

The shrinking number of primary-care physicians is reaching a tipping point

September 5th, Washington Post 

I’ve been receiving an escalating stream of panicked emails from people telling me their longtime physician was retiring, was no longer taking their insurance or had gone concierge and would no longer see them unless they ponied up a hefty annual fee. They said they couldn’t find another primary-care doctor who could take them on or who offered a new-patient appointment sooner than months away. Read More

Employers expect a 7% hike in health care costs in 2024

September 1st, BenefitsPRO

One notable change from last year is increased utilization because of delayed preventive or elective care during the pandemic, which declined from 12% to 4%. Read More

Employers need to step up: Insist on high-quality health care, says report

September 1st, 2023  BenefitsPRO

Employers account for more than $1 trillion in health care spending annually, which is why they should create an information ecosystem to access provider quality information, says a new report.  Read More

How self-funding and primary care can save even more

August 31st, BenefitsPRO 

Implementing a primary care model into a self-funded plan can help employers build a benefits suite to match their businesses: smart, efficient and with peoples’ best interests at heart. Read More

7 ways health plans are containing weight loss drug costs

August 29th, Beckers Payer

Around 6 in 10 health plans have provider education in place to promote alternative options to costly GLP-1 drugs like Ozempic and Wegovy for obesity and diabetes treatment, according to a survey from diabetes management provider Virta Health. Read More

8.5% increase in employers’ health care costs forecast for 2024

August 24th, Business Insurance 

U.S. employers can anticipate an 8.5% surge in health care expenses in 2024, bringing the average cost per employee to more than $15,000 per employee, according to Aon PLC, reports Plansponsor. This predicted rise is almost double the 4.5% increase observed from 2022 to 2023, with the current average budgeted cost at $13,906 per employee. Read More

More than half of health plan members less than happy with coverage, survey finds

August 23rd, BenefitsPRO

Overall, the survey found that 38% of employer sponsored plan members were “extremely satisfied” with their plan. Read More

Medical debt is squeezing millions of middle-class Americans, report says

August 21st, Axios

Middle-class Americans are the most likely to be saddled with medical debt, with nearly 1 in 4 — or roughly 17 million people — having unpaid medical bills, according to a report shared first with Axios from center-left think tank Third Way. Read More

Viewpoint: Healthcare is overrun with 'middlemen, actors and sub-actors'

August 21st, Becker’s Hospital Review 

Healthcare is increasingly inundated with “middlemen, actors and sub-actors” — companies devoted to niche causes that promise to fill perceived gaps in the healthcare system, according to Sachin Jain, MD, president and CEO of SCAN Group and SCAN Health Plan.  Read More

Employee retention higher priority than revenue and sales growth, study finds

August 18th, BenefitsPRO

Demonstrating genuine and consistent communications surrounding DEI initiatives can positively impact the working environment for all employees.  Read More

In US, GLP-1s cost hundreds more than similar nations

August 18th, Beckers Hospital Review

Glucagon-like peptide-1 receptor agonists, which include Ozempic and Mounjaro, cost between five to 10 times more in the U.S. than other wealthy nations, according to research KFF published Aug. 17. Read More

Amazon Pharmacy launches ‘automatic coupons’ for $35 insulin products

August 17th, BenefitsPRO

Following Biden’s $35 cap on insulin costs for seniors on Medicare and three pharma companies agreeing to the cost reduction, Amazon is now giving its online customers instant discounts for the diabetes drug. Read More

What will the next decade bring for value-based care?

August 17th, Beckers Payer

Payer executives are expecting value-based care to take off in the next decade.  Though the number of healthcare dollars tied to value-based arrangements has increased, a report from the Healthcare Payment Learning and Action Network found around 40 percent of healthcare dollars in 2021 were still tied to fee-for-service-only arrangements Read More

Senators ask IRS to launch probe of nonprofit hospitals’ tax-exempt status

August 15th, BenefitsPRO 

A group of four bipartisan senators, including Sen. Charles Grassley, sent a letter to tax commissioners over concerns that these hospitals may not be providing charity care to communities as required for their tax-exempt status. Read More

Self-funding: 4 misconceptions & 4 questions

August 14th, Benefits Hospital Review

In recent years, many employers with fully-insured plans have experienced sticker shock as they watched their premiums rise. Healthcare costs, in general, are trending upward, reflecting not only inflation but changes in federal policies & healthcare utilization. Read More

Clients hesitant to self-fund? Take it down a level

August 10th, BenefitsPRO

If self-funding sounds like too big a leap from a fully insured health plan, level funding is a strong option for your clients or company to consider. Read More

Wegovy reduces cardiovascular risks in phase 3 trial

August 8th, Benefits Hospital Review

Novo Nordisk’s Wegovy, a weight loss drug, showed a 20 percent reduction in major adverse cardiovascular events in a phase 3 trial, the drugmaker said Aug. 8. Read More

Why insurers are paying double for the same procedure in the same hospital

August 7th, Axios

Hospitals charge commercial health plans two to three times more than what they charge the same insurer’s Medicare Advantage plans for the same procedure, a new study in Health Affairs found. Read More

Poll: Nearly Half of Adults Would Be Interested in Prescription Weight-Loss Drugs, But Enthusiasm Fades Based on Lack of Coverage and Risk of Regaining Weight

August 1st, BenefitsPRO

Nearly half (45%) of the public are at least somewhat interested in taking a prescription weight-loss drug, including many who say they only want to lose a little weight, though many people lose interest when presented with potential financial and medical drawbacks, the latest KFF Health Tracking Poll reveals. Read More

How real-time benefit transparency is helping payers, providers and care managers

August 1st, BenefitsPRO

As the health care landscape evolves, the adoption of real-time benefit transparency will continue to play a vital role in maximizing the benefits of health plans. Read More

Health plans are dropping weight loss drugs like flies

July 31st, Beckers Payer

As demand for GLP-1s such as Ozempic and Wegovy continues to surge, payers and self-insured employers are dropping coverage for the weight loss medications left and right Read More

Key PBM reform bills advance in Senate, House committees

July 28th, BenefitsPRO

As Congress scrutinizes the pharmacy benefit manager industry, on Wednesday, the Senate Finance and House Ways and Means committees advanced legislation that would regulate PBM’s control over drug prices. Read More

Inflation, shifts in coverage options could impact 2024 health premium rates

July 26th, BenefitsPRO

Multiple factors are converging to potentially influence 2024 health insurance premium rates. They include inflation, the end of the COVID-19 public health emergency, and shifts in coverage options offered by small employers. Read More

Ascension drops weight loss drug coverage for employees

July 24th, Beckers Payer

St. Louis-based Ascension has dropped coverage for weight loss drugs such as Wegovy from its employee health plan. Read More

20 states with the highest percentage of price transparency compliant hospitals

July 24th, Beckers Hospital Review 

A July 20 report from patientrightsadvocate.org found that 36 percent of the 2,000 hospitals reviewed are complying with the federal price transparency rule that went into effect in January 2021. Read More

Obesity is complicated: How best to cover, or not cover, the new weight loss drugs

July 24th, BenefitsPRO

Coverage of Ozempic and Wegovy could conservatively drive employer spend up by 25% annually, so to give the new drugs the best opportunity to have the best effect, employers must think comprehensively and long-term.  Read More

Medical Debt Is Making Americans Angry. Doctors and Hospitals Ignore This at Their Peril.

July 21st, KFF Health News

For Emily Boller, it was a $5,000 hospital bill for a simple case of pink eye that took four years to pay off. For Mary Curley, it was the threatening collection letters from a lab that arrived more than 2½ years later, just as her husband lost his job and the family was fighting to save their home. Read More

The cost implications of new weight loss treatments for plan sponsors

July 21st, BenefitsPRO

Could drugs in the latest generation of medications approved to promote weight loss be a solution?  Read More

The top 10 high-cost claim conditions for 2022

July 20th, BenefitsPRO

More than a third of total claim reimbursements can be attributed to the top three conditions in Sun Life’s latest report.  Read More

The drug price battle playing out in Congress (and on those TV ads)

July 17th, BenefitsPRO

In recent months ominous ads about prescription drugs have flooded the TV airwaves – and Congress is paying attention: House and Senate members have launched nine bills that take aim at pharmacy benefit managers. Read More

Ozempic demand is driving up care costs nationwide

July 13th, Beckers Payer

Health insurers around the country are looking to raise premiums next year in part to meet the high demand for expensive weight-loss drugs such as Ozempic. Read More

Payer price transparency data has been available for a year. Is it lowering costs?

July 12th, Beckers Payer

Price transparency data is available, but several changes are needed to actually bring about lower healthcare costs, researchers at Washington, D.C.-based Georgetown University’s Center for Health Insurance Reforms wrote.  Read More

What You Need to Know About the Drug Price Fight in Those TV Ads

July 10th, KFF Health News

In recent months ominous ads about prescription drugs have flooded the TV airwaves. Perhaps by design, it’s not always clear who’s sponsoring the ads or why. Read More

Employers are increasingly suing their health plan for claims data

July 7th, Beckers Payer

Lawsuits from large companies and employers are increasingly being filed against third-party health plan administrators in an effort to access complete employee medical claims data. Read More

Will the doctor see you now? The changing primary care landscape

June 30th, BenefitsPRO

Hospitals, insurers like Aetna-CVS Health and corporate giants like Amazon are on a buying spree, snapping up primary care practices, furthering a move away from the neighborhood doctor. Read More

Specialty drugs: employers are weary (and for good reason)

June 29th, BenefitsPRO

The specialty drug pipeline is evolving and contributing to rising costs. Over the last 10 years, the total specialty-drug market spend has approximately doubled, and is expected to hit $310 billion this year. Read More

Healthcare costs will grow 7% next year, PwC finds

June 29th, PwC

Healthcare costs are expected to rise 7% next year as inflation drives providers to seek rate increases from insurers and pharmaceutical costs rise, according to PwC’s annual report. Read More

Experimental drug could offer more weight loss than any drug now on the market, study finds

June 26th, NBC News

The experimental drug, retatrutide, helped people lose, on average, about 24% of their body weight, the equivalent of about 58 pounds, in a mid-stage clinical trial, the company said Monday from the American Diabetes Association’s annual meeting in San Diego. The findings were simultaneously published in The New England Journal of Medicine.  Read More

Lawmakers draft another PBM bill

June 15th, Beckers Hospital Review

Six senators introduced a new bill targeted at shrinking the pharmacy benefit manager industry’s influence, which adds to the stack of at least seven similar bills wading through Congress.   Read More

Obesity changes the brain, with ‘no sign of reversibility,’ expert says

June 12th, CNN

Obesity may damage the brain’s ability to recognize the sensation of fullness and be satisfied after eating fats and sugars, a new study found. Read More

Payers crack down on Ozempic prescriptions

June 12th, Beckers Payer

Some health insurers are cracking down on off-label prescriptions of new weight loss drugs such as Ozempic, the Washington Post reported June 12. Read More

High drug prices: Why 9 million Americans are not taking medications as prescribed

June 6th, BenefitsPRO

More than 8% of Americans (aged 18 to 64) have skipped, delayed or reduced the amount of prescribed medication because of cost concerns, according to the CDC. Read More

What technology will have the biggest impact on healthcare, per ChatGPT

June 5th, Beckers Hospital Review

Artificial intelligence and machine learning algorithms will be the technology that has the biggest impact on healthcare, according to ChatGPT.  Read More

Ford sues Blue Cross, accusing insurer of price fixing that led to ‘astronomical profits’

June 2nd, BenefitsPRO

Ford Motor Co., which paid $500 million in premiums to BCBS, alleges it was “overcharged” for health insurance in a new lawsuit that’s related to the $2.7 billion antitrust settlement that BCBS and member companies reached in 2020. Read More

Cuban's pharmacy to sell Humira biosimilar for $570

June 1st, Beckers Hospital Review

Mark Cuban Cost Plus Drug Co. announced that beginning in July it will sell a branded Humira biosimilar known as Yusimry. It is the first biologic product offered by the company. Read More

70% of Americans say the health care system has failed them

May 31st, BenefitsPRO

The U.S. health care system is not meeting people’s needs, says the American Academy of Physician Associates: 56% of patients said they wait over a week to get an appointment, while 49% say providers don’t always listen to them. Read More

Are US prescription drug prices really '10 times those of other nations'?

May 30th, BenefitsPRO

Sen. Bernie Sanders, chair of the Senate Health, Education, Labor and Pensions Committee, made this bold statement, which some say contains elements of truth, however, it’s why he’s made lowering drug costs a top priority. Read More

Healthcare costs for average family of four surpass $30K, study says

May 30th, Beckers Hospital Review

Healthcare costs for an average family of four reached $31,065, as healthcare costs jumped 5.6 percent this year, according to a new report from consulting firm Milliman.  Read More

Navigating the complicated world of health care

May 24th, BenefitsPRO

How can employers assist members in receiving the right care from the right provider at the right time? Cost and quality navigation overlay programs can help.  Read More

Employees lack benefits information for well-informed decisions, studies find

May 16th, BenefitsPRO

A very strong majority of survey respondents, 81% said they would welcome benefit information outside the open enrollment period. Read More

FDA greenlights menopause drug for hot flashes

May 15th, Beckers Hospital Review

The FDA on May 12 approved Astellas’ Veozah — a once-a-day pill meant to treat hot flashes associated with menopause. The drug is an alternative to hormone replacement therapies typically used to treat hot flashes, flushing and chills. However, hormone therapies are not an option for all women. Read More

Senate panel advances bill that would ban spread pricing

May 11th, Fierce Healthcare

The PBM bill was among four passed by the Senate Health, Education, Labor and Pensions committee on Thursday, one day after the senators heard input from major PBM and pharmaceutical manufacturer executives. (Alejo Vazquez/iStock/Getty Images Plus) Read More

PBMs, the Brokers Who Control Drug Prices, Finally Get Washington’s Attention

May 11th, KFF Health News

For two decades, patients and physicians eagerly awaited a lower-cost version of the world’s bestselling drug, Humira, while its maker, AbbVie, fought off potential competitors by building a wall of more than 250 patents around it.  Read More

Employers not ready to cover new weight-loss drugs, Cigna CEO says

May 5th, BeckersPayer

Employers are hesitant to cover the cost of GLP-1 drugs for their employees, the Cigna Group CEO David Cordani said. Read More

Novo Nordisk rivals see room to compete in $100 billion weight-loss drug market

May 4th, Reuters

The enormous demand for weight-loss treatments like Novo Nordisk’s (NOVOb.CO) Wegovy could support as many as 10 competing products with annual sales reaching up to $100 billion within a decade, mostly in the United States, industry executives and analysts said. Read More

Drug pricing battle: House and Senate both targeting pharmacy benefit managers

April 25th, BenefitsPRO

On Friday, the House Appropriations Committee approved a bill that would prevent “spread pricing” and increase regulations on PBMs, two days after the Senate unanimously passed its version. Read More

What's next on the No Surprises Act

April 24th, Axios

The No Surprises Act may have shielded patients from unexpected medical bills, but it’s left a bureaucratic mess, with providers and insurers fighting over who’ll cover the costs and Congress weighing whether to step back in. Read More

Cash prices often lower than negotiated rates, study finds

April 11th, BenefitsPRO

“Hospitals have full discretion to set their chargemaster prices, which, on average, are more than four times the actual cost of care delivery,” the Health Affairs study says. Read More

High Inflation and Housing Costs Force Many Americans To Delay Needed Care

April 7th, KFF Health News

At a health-screening event in Sarasota, Florida, people gathered in a parking lot and waited their turn for blood pressure or diabetes checks.  Read More

PBMs are ‘gangsters,’ Ohio AG alleges in lawsuit against Express Scripts, 6 others

March 29th, BenefitsPRO 

As pharmacy benefit managers face scrutiny on Capitol Hill, a new Ohio lawsuit alleges Express Scripts and Prime Therapeutics used a Switzerland-based company to illegally drive up drug prices.  Read More

PBM drug pricing transparency reform bill headed to the full Senate

March 28th, BenefitsPRO

The bipartisan pharmacy benefit manager bill, which was approved by a Senate committee, would make it illegal to charge health plans and payers more for a prescription drug than what PBMs reimburse to the pharmacy. Read More

Cigna's PBM, two others sued in Ohio over drug price fixing

March 27th, Reuters

Ohio on Monday filed a lawsuit accusing Cigna Group (CLN), Humana Inc (HUM.N) and others of colluding to drive up prescription drug prices by charging exorbitant fees for pharmacy benefit management services. Read More

How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them

March 25th, ProPublica

Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files. “We literally click and submit,”one former company doctor said Read More

Overworked physicians consider exiting roles as pay rates drop

March 23rd, Beckers Hospital Review

Two out of three physicians are considering leaving their roles as overworking continues to be a widespread challenge and physician compensation remained flat or was down for many specialties last year, according to Doximity’s 2023 “Physician Compensation Report.” Read More

Can employers really impact employee health for the better?

March 16th, BenefitsPRO

The fact is, employers not only have the power to impact the health of their employees; they can’t afford not to.  Read More

US to fine drugmakers over price hikes for 27 meds

March 15th, Beckers Hospital Review

The Biden administration said March 15 it will fine pharmaceutical companies over 27 drug prices that rose faster than the inflation rate. Pfizer led the pack with fines for five drugs, while the other companies had one to two products. One of the provisions of the Inflation Reduction Act, which was passed in August and hit  pharma lobby groups hard, allows the federal government to hand drugmakers tax penalties if prices for their prescription drugs in Medicare Part B outpace the rate of inflation.  Read More

High hospital prices inflict pain, but treatment options exist

March 7th, BenefitsPRO

In 2020, national spending on health care increased 9.7% to $4.1 trillion, more than double the increase in 2019. The first step in curing a disease is to diagnose it and determine its root cause. Our nation’s health care system has been ailing for years, plagued by steadily rising prices that threaten the ability to access life-saving treatments for a growing number of working people.  Read More

Volume of disputed claims, legal rulings creating obstacles for No Surprises Act

March 6th, 2023 Benefits PRO

Most people agree that making the health care system more transparent is a worthy objective; but the devil remains in the details. “We work in the health care world, and many of us still don’t understand the explanation of benefits,”  Read More

Feds open another probe into PBM practices

March 2nd, Beckers Hospital Review

Nine months after the Federal Trade Commission launched an inquiry into pharmacy benefit practices, the House Committee on Oversight and Accountability opened an investigation March 1. Read More

4 measures needed to create shoppable healthcare beyond price transparency

February 24th, 2023 BeckersPayer

Beyond federal price transparency rules, there are more transformative policies that could be implemented to create a shoppable and consumeristic environment in healthcare, according to Harvard Business Review analysts. Read More

High-deductible health plans are moving health outcomes in the wrong direction

February 21st, 2023 BeckersPayer

As the number of Americans enrolled in high-deductible health plans Continues to grow, recent studies conducted by researchers at some of the nation’s top hospitals and medical schools have linked HDHPs with worse health outcomes, less spending on preventive care, and higher utilization rates of emergency rooms.  Read More

Health care price transparency mandates are in effect: What can HR leaders do?

February 16th, 2023 BenefitsPro

As of January 1st, self-insured employers and health insurance issuers with plan years starting in 2023 were required to give health plan members access to an online, shoppable tool with pricing information for 500 of the most commonly covered medical items and services. Read More

Ongoing challenges with hospital price transparency

February 10th, 2023 Kaiser Health News

Since 2021, hospitals have been required to publicly post standard charges and negotiated rates for the common health services and procedures. These price transparency requirements are intended to enable patients to compare prices and promote competition in the health care markets. Additionally, these data have been used by researchers for conducting research on prices and competition in the health industry.  Read More

Era of ‘Free’ Covid Vaccines, Test Kits, and Treatments Is Ending. Who Will Pay the Tab Now?

February 10th, 2023 Kaiser Health News

The White House announced this month that the national public health emergency, first declared in early 2020 in response to the pandemic, is set to expire May 11. When it ends, so will many of the policies designed to combat the virus’s spread. Read More

Pharma spends more on ads pushing low-value drugs

February 3rd, 2023  HealthLeaders Media

A new study highlights the complex dynamic between consumer advertising for prescription drugs and patients and clinicians.  Read More

Health care spending in the US is nearly double that of other wealthy nations

January 31st, 2023 The Hill

In the U.S., health care spending made up 17.8 percent of GDP in 2021. This is nearly double that of other high-income countries. Read More

US spends most on healthcare but has worse outcomes: 6 report findings

January 31st, 2023 Beckers Hospital Review

The U.S. spends two to four times as much on healthcare as most other high-income countries, but the health outcomes lag behind, a new Commonwealth Fund study found.  Read More

Leapfrog: Employers Give Health Plans a ‘C’ Letter Grade

January 26th, 2023 MedCity News

A survey from The Leapfrog Group asked employers to give their health plans an “A” through “F” letter grade. From those letter grades, Leapfrog calculated the health plans’ average Grade Point Average (GPA) on a 4.0 scale. Health plans received a 2.29 GPA in 2022, a slight decrease from Leapfrog’s prior survey in 2020, which had a 2.57 GPA. Read More

Cost of health care forcing Americans to put off treatments

January 24th, 2023  BenefitsPro

A new Gallup poll says those postponing treatments rose 12 points to 38%. Read More

48% of physicians are happy at work, survey finds

January 20th, 2023 Beckers Hospital Review

Physicians’ happiness fell amid the pandemic and is not rebounding easily, according to Medscape’s 2023 Physician Lifestyle and Happiness Report. Read More

UnitedHealth Group posts $4.9B profit in fourth quarter

January 13th, 2023 Beckers Payer

UnitedHealth Group recorded double-digit growth in revenues year over year across its lines of business at UnitedHealthcare and Optum, according to the company’s fourth quarter earnings report released Jan. 13. Read More

How health insurance may have made health care more expensive

January 8th, 2023 CNBC

Widespread medical debt is a uniquely American problem. Roughly 40% of U.S. adults have at least $250 in medical debt, according to a survey conducted by Kaiser Family Foundation.  Read More 

Around 91% of Americans worried about increasing health care costs

December 30th, 2022 BenefitsPRO

An additional 83% of respondents are worried about what the nation as a whole spends on health care. Read More

The 10 Most-Read CFO Stories of 2022

December 28th,  2022 CFO.com

 The top CFO stories that captured finance executives’ attention this year. Read More

$4.3T US healthcare spend represents 18.3% of GDP: 8 notes

December 21st, 2022 Beckers Hospital Review

U.S. health care spending increased 2.7 percent in 2021, reaching $4.3 trillion or $12,914 per person, according to CMS. Read More

Can health systems compete with disruption from CVS, Walgreens?

December 19th, 2022 Beckers Hospital Review

Recent moves from CVS and Walgreens show that the pharmacy retail giants are making leaps into healthcare spaces they’ve never touched — but hospitals aren’t sweating yet. Read More

Reference-based pricing can keep your benefit costs down

November 18th,  2022 BenefitsPRO

By adding transparency and breaking the upward spiral of health care costs, reference-based pricing leads to a wining situation.  Read More

Healthcare spending hit $4.3 trillion in 2021: 7 things to know

December 14th, 2022 Beckers Hospital Review

A new CMS analysis estimated U.S. healthcare spending increased by 2.7 percent to $4.3 trillion in 2021, Health Affairs reported Dec. 14. Read More

Employers Use Patient Assistance Programs to Offset Their Own Costs

December 6th,  2022 Kaiser Health News 

Anna Sutton was shocked when she received a letter from her husband’s job-based health plan stating that Humira, an expensive drug used to treat her daughter’s juvenile arthritis, was now on a long list of medications considered “nonessential benefits.”  Read More

2023 global health care benefit costs to reach highest level in 15 years

November 18th, 2022 BenefitsPRO 

Old solutions, like cost shifting, will not work – companies that don’t innovate, strategize and find new solutions will fall behind in their ability to retain key talent, according to a new report.  Read More

Humira biosimilars earn spot on OptumRx's formulary

November 16th, 2022 Beckers Hospital Review 

OptrumRx, UnitedHealth’s pharmacy benefit manager, will keep AbbVie’s best-selling rheumatoid arthritis drug Humira on its formulary in 2023 alongside three competing biosimilar versions set to debut next year, Bloomber reported Nov. 15.  Read More

High cost of health care is top concern as employers compete for workers, survey finds

November 4th 2022 BenefitsPRO

8 in 10 employers say health care costs affect their ability to remain competitive. The soaring cost of health care is harming the ability of many employers to recruit and retain workers.  Read More

Cash for Colonoscopies: Colorado Tries to Lower Health Costs Through Incentives

November 2nd, 2022 US News 

State employees in Colorado are being asked to be better consumers when shopping for health care services. And if they choose lower-cost and higher-quality providers, they could get a check in the mail for a portion of the savings.  Read More

Benchmark KFF Survey Finds Annual Family Premiums for Employer Coverage Average $22,463 This Year

October 27th, 2022 Kaiser Family Foundation

Annual Family Premiums for Employer Coverage Average $22,463 This Year, with Workers Contributing an Average of $6,106, Benchmark KFF Employer Health Benefit Survey Finds Read More

U.S. leads world in health care administrative costs and half of it is wasteful

October 17th, 2022 BenefitsPRO

Administrative costs account for 15% to 30% of U.S. health care spending – and at least half of that spending is wasteful. Researchers note that not all administrative spending is wasteful, making a distinction between spending and waste.  Read More

As Giant Hospitals Get Bigger, an Independent Doctor Feels the Pinch

October 13th, 2022 Kaiser Health Network 

“If I could go back 30 years, I wouldn’t become a doctor,” says Dr. Andrew Bush, whose practice, Central Carolina Orthopaedic Associates, operates in Sanford, North Carolina. “Looking back at life, this was the wrong choice.”  Read More

Bain: 25% of clinicians want out of healthcare

October 11th, 2022 Beckers Hospital Review

One quarter of U.S. physicians, advanced practice providers and nurses are considering switching careers and one third are considering switching employers, according to newly released results from a survey conducted by Bain & Company. Read More

Physicians' love-hate relationship with incentive bonuses: Medscape

October 11h, 2022 Beckers Hospital Review 

Physicians have weighed in on the benefits and disadvantages of incentive bonuses, a recent Medscape study found.  Medscape surveyed 406 physicians between Aug. 17 and Sept. 1. Results were split, with 49 for bonuses and 51 percent against them. Those polled were also split 50-50 on the question of whether bonuses increase productivity.  Read More

At least half of healthcare administrative spending is wasteful, report says

October 10th, 2022 Beckers Hospital Review

Administrative spending accounts for 15 to 30 percent of healthcare spending in the U.S. and at least half of that “does not contribute to health outcomes in any discernible way,” according to a report published Oct. 6 in Health Affairs  Read More

How employers will control high health care costs in 2023

October 10th, 2022 BenefitsPRO

A 7.5% increase is expected due to delayed preventive care during the pandemic, however, employers are hesitant to increase employees’ portion of the benefit cost coverage.  Read More

Poll by Gallup and West Health shows 75% of Americans grade the affordability of US healthcare as a D or F

October 6th, 2022 Fierce Healthcare

Gallup West Health Value-Based cost effectiveness system costs fell to the bottom of the class in a Gallup-West Health poll on American healthcare. Only 7% of Americans give the cost of care an A or B rating. For value of care, 7% gave the system a high perceived value while 57% said value was inconsistent and 36% said it was poor. (Getty)  Read More

Bringing pharmacy costs into the light: Transparency is key to capping costs

September 27th, 2022 BenefitsPRO

Regardless of the path to reducing prescription drug costs, a fundamental starting point is transparency — supplying all stakeholders with clear data on where the money is going and what it’s for.   Read More

Mark Cuban's pharmacy teams up with 1st PBM, won't make its own

September 27th,  2022 Beckers Hospital Review

Mark Cuban’s generic drug business, Cost Plus Drug Co., won’t build its own pharmacy benefit manager after snagging its first PBM to integrate its services, Cost Plus Drug Co. founder and CEO Alex Oshmyansky, MD, PhD, told Becker’s. Read More

51% of businesses struggle to afford insurance for their employees: survey

Septemer 26th, 2022 Beckerspayer.com

Many owners of small and midsize businesses say they are struggling with the cost of healthcare premiums for their employees, a new survey found.  Read More

Employers' coming health care crunch

September 19th, 2022 Axios

All signs are pointing toward significantly higher health costs in the employer market next year, which will translate into larger-than-normal premium increases.  Read More

How voluntary benefits have gone from important to critical

September 15th, 2022 BenefitsPRO

The following challenges help illustrate why voluntary benefits have been pushed to the forefront, the impact they have on employers and the role of benefits advisors in this new environment.   Read More

More than 60% of physicians experienced burnout in 2021, study finds

September 14th, 2022 Beckers Hospital Review

Physicians’ emotional exhaustion and depersonalization scores were worse in 2021 than in 2020, according to a study published in Mayo Clinic Proceeding on Sept. 13.  Read More

3 reasons why owning pharmacy benefits data matters

August 31st,  2022 BenefitsPRO

There’s a long list of reasons why data ownership is a must, but these three should be enough to convince brokers and employers to take action.  Read More

Health care costs expected to be $13,800 per person in 2023

August 22nd,  2022 BenefitsPRO

“Employers are budgeting higher due to uncertainty and the anticipation that inflationary pressures will increase the cost of health care services,” says Debbie Ashford North America chief actuary for health solutions at Aon. Read More

Upended: How Medical Debt Changed Their Lives

August 18th,  2022 Kaiser Health News 

Four in 10 Americans have delayed or skipped healthcare treatments in the last six months due to rising healthcare costs, according to an Aug. 4 report from Gallup. Read More

4 in 10 Americans cut spending to cover healthcare costs

August 5th,  2022 Beckers Hospital Review

Four in 10 Americans have delayed or skipped healthcare treatments in the last six months due to rising healthcare costs, according to an Aug. 4 report from Gallup. Read More

Employees are increasingly on the hook for their medical costs

July 29th, 2022 Axios

The growth of high-deductible health plans led to people with employer-sponsored coverage paying for a larger share, on average, of their health care costs between 2013 and 2019, according to a new analysis by the Employee Benefit Research Institute.  Read More

Conflicts of interest in the health insurance industry: “Who watches the Watchmen?”

July 26th, 2022 BenefitsPRO

When people or companies are put into positions of power without oversight, what is to prevent them from taking advantage of the situation? That question is at the heart of a lawsuit between the School Board of Osceola County and Gallagher Benefit Services.         Read More

Insurers propose 10% premium hike for 2023

July 25th, 2022 BenefitsPRO

Companies are seeking higher premium increases, mostly due to rising prices paid to hospitals, doctors and drug companies, as well as increases use of services by enrollees. Read More

5 specialties that drive the most revenue to hospitals

July 19th, 2022 Becker’s Hospital Review

Payment models in healthcare are evolving, but physicians still drive revenue to hospitals through patient, procedure, test and treatment volume, according to an analysis by Merritt Hawkins released July 18. Read More

Will new health insurer transparency rules spark a health care revolution?

July 1st, 2022 Kaiser Health News

Tens of thousands of employers who buy insurance coverage for their workers will get this more-complete pricing picture — and may not like what they see. Read More

FTC to examine business practices of several large PBMs

June 15th, 2022 BenefitsPRO

The inquiry “will bring their dirty laundry out into the open,” said the head of the National Community Pharmacists Association.  Read More

Most hospitals failing price transparency rule

June 8th, 2022 Beckers Hospital Review

Fewer than 6 percent of hospitals are fully compliant with the Hospital Pricing Transparency Law, according to a study published in the Journal of the American Medical Association published June 7. Read More

FTC to probe PBM industry practices

June 7th, 2022 Beckers Payer

The Federal Trade Commission ilaunching an inquiry into the pharmacy benefit manager industry and requiring the six largest PBMs to provide information and records regarding their business practices. Read More

New bill would crack down on PBM spread pricing, increase transparency

May 30th, 2022 BenefitsPRO

The bipartisan Pharmacy Benefit Manager Transparency Act of 2022 would empower FTC to hold PBMs accountable. Read More

The barriers to hospital price transparency compliance

May 13th, 2022 Beckers Hospital Review

Although CMS’ price transparency rule went into effect in January 2021, hospitals have been slow to comply with the regulation.         Read More

UnitedHealth was this quarter’s most profitable payer-again

May 9th, 2022 Fiercehealthcare.com

Each of the six major national payers exceeded Wall Street’s expectations for profit in the first quarter, with UnitedHealth Group out in front as the most profitable company.  Read More

Specialty drug costs continue to vex employer-sponsored health plans

May 4th, 2022      BenefitsPro

To address high costs, plan sponsors are trying a variety of approaches. Read More

40 Florida medical practices sue UnitedHealth

May 4th, 2022       Becker’s Hospital Review

Forty Florida medical practices are suing UnitedHealth over the pricing and payment of medical bills, Lawstreet Media reported May 4  Read More

'It really is frightening': Health plans brace as specialty drugs hit 50% of prescription spending

May 4th, 2022     Becker’s Hospital Review

Payers and pharmacy benefit managers say specialty drugs now account for 50 percent or more of the total prescription spending they manage, Forbes reported May 3.  Read more

Employees willing to pay for better benefits

April 21st, 2022   BenefitsPRO

Employees say retirement programs and health care benefits are key factors in their decision to stick with their employer.  Read More

Hospital expenses per inpatient day across 50 states

April 25th, 2022    Becker’s Hospital Review

Below are the adjusted expenses per inpatient day in 2020, organized by hospital ownership type, in all 50 states, according to the latest statistics from Kaiser State Health Facts.   Read More

CFOs cite healthcare benefit expenses as a top concern

Healthcare benefits typically represent the largest expense compared to other operating expenses.

Investing in employee health is key to retention and recruitment

Employers who are hoping to retain and attract talent need to focus on the benefits workers want the most. 

How direct-contracting initiatives can power employer-funded health plans

Employers and their administrative partners can leverage data to adopt a holistic approach to the health of their employees and their families. 

Impact of pandemic on commercial health insurance: Spending, risk both increasing

April 5th, 2022    BenefitsPRO

The ripple effect of the pandemic will be felt not only for the rest of 2022 but well into the future.  Read More

UnitedHealth working to avoid class-action lawsuit from 1K independent pharmacies

UnitedHealth Group is working to avoid a major class-action lawsuit from around 1,000 independent pharmacies nationwide for alleged under-reimbursements totaling more than $100 million, according to Bloomberg

Legal Alert: Deadline to Publish Certain Machine-Readable Files Pursuant to Final CMS Transparency Fast Approaching

On October 29, 2020, in response to President Trump’s executive order on Improving Price and Quality Transparency in American Healthcare, CMS Released its Transparency in Coverage Final Rules (“TiC Final Rules”) which require, among other things, non-grandfathered group health plans and health insurance issuers offering health insurance in the individual and group markets to make available to the public (including stakeholders such as consumers, researchers, employers and third-party developers) three separate machine-readable files including detailed pricing information related to (1) negotiated rates for all covered items and services between the plan or issuer and in-network providers, (2) historical payments to, and billed charges from, OON providers (a minimum of 20 entries must be available to ensure privacy) and (3) the in-network negotiated rates and historical net prices for all covered prescription drugs by plan or issuer at the pharmacy location level.  

Half of Americans fear major health event will lead to bankruptcy, study finds

10 health insurers sending premium credits to members

August 14th, 2020     Becker’s Hospital Review

Here are 10 payers that are returning premium revenue to members due to lower healthcare costs during the COVID-19 pandemic. Read More

What's driving 2021 health insurance rate changes? 4 things to know

Average hospital expenses per inpatient day across 50 states

Aetna, Optum misused CPT codes to hide administrative charges, AMA says

February 26th, 2020     Becker’s Hospital Review

The American Medical Association said Aetna and Optum misused Current Professional Terminology codes to hide administrative costs, according to a judicial advocacy post. Read More

Drug spending on the rise in employer-based health plans, report finds

Voluntary Benefits
Ancillary Benefits