July 31, 2023
Payers | Tea Leaves
  • A key Senate committee on Wednesday advanced bipartisan legislation aimed at regulating pharmacy benefit managers (PBMs), the intermediaries in the prescription drug supply chain who negotiate discounts with drug companies on behalf of insurance plans. While other committees have also passed PBM reform bills, the Finance Committee has jurisdiction over Medicare and Medicaid, which make up a large portion of U.S. health spending. Among other provisions, the legislation would delink PBM compensation from the price of the drug, which would remove an incentive for PBMs to favor higher-priced drugs. The legislation would also ban spread pricing, which is when a PBM charges Medicaid more for prescription drugs than they pay. (Article here)
  • Most Medicare Advantage (MA) enrollees use one or more supplemental benefits, with most health plan members using multiple benefits, according to a newly released report from the Elevance Health Public Policy Institute. The report finds that 83 percent of dual-eligible and 75 percent of non-dual-eligible individuals used at least one supplemental benefit a year. Those figures only drop to 64 percent and 48 percent, respectively, for using at least two different supplemental benefits. It also concluded that dual-eligible enrollees were more likely to live in a food desert, so they are more likely to self-select plans with strong supplemental benefit offerings. (Article here)
  • On Wednesday, Nevada insurance officials announced that they’ve decided to liquidate operations of the insurtech Friday Health Plans in that state and presented timelines for the approximately 2,000 member Nevadans to find new coverage. Of the seven states in which Friday Health Plans operated, Nevada had been the last holdout in terms of giving the insurtech a chance to right its ship and keep members covered until the end of the year. The court-ordered liquidation date is September 1. (Article here)