Insurers To Shift A Bit From Medicare Advantage To Special Needs Plans
Health insurance companies are expected to pull back slightly from Medicare Advantage investing in 2025. Instead, Modern Healthcare reports, they will focus on Dual-Eligible Special Needs Plans, or D-SNPs, which cover people who are eligible for both Medicare and Medicaid. Other industry news is on employer plans, executive jobs, and more.
Modern Healthcare:
Medicare Advantage Insurers Bank On Special Needs Plans In 2025
Investing in products for individuals with complex medical needs has emerged as a key tactic for health insurers endeavoring to revive Medicare Advantage margins. Leading insurance companies pulled back slightly from Medicare Advantage for the coming plan year amid financial strains but are continuing a big push into the market for Dual-Eligible Special Needs Plans, or D-SNPs, which cover people who are eligible for both Medicare and Medicaid, according to analyses of preliminary data about the 2025 Medicare Advantage marketplace. (Berryman, 10/9)
KFF Health News:
Employers Haven’t A Clue How Their Drug Benefits Are Managed
Most employers have little idea what the pharmacy benefit managers they hire do with the money they exchange for the medications used by their employees, according to a KFF survey released Wednesday morning. In KFF’s latest employer health benefits survey, company officials were asked how much of the rebates collected from drugmakers by pharmacy benefit managers, or PBMs, is returned to them. (Allen, 10/9)
The Wall Street Journal:
Pfizer CEO’s Job Is At Risk. A Shot Of Discipline Could Help
When former executives team up with an activist investor to “help” a struggling company, it is often bad news for the current chief executive. That is one implication behind activist investor Starboard Value’s $1 billion stake and its push to make changes at Pfizer, which The Wall Street Journal reported has support from former Pfizer Chief Executive Ian Read and former Chief Financial Officer Frank D’Amelio. Another important takeaway is that investors are eager to see a more disciplined and focused development strategy from the company. (Wainer, 10/8)
Modern Healthcare:
Teladoc COO Michael Waters To Depart At End Of 2024
Michael Waters, chief operating officer of Teladoc Health, will leave his position at the end of the year. Waters will exit effective Dec. 31 in connection with a change in the executive reporting structure, according to a Sept. 27 Securities and Exchange Commission filing. He has served as Teladoc's COO since July 2022. (Desilva, 10/8)
Stat:
Compounding Group Sues FDA For Removing Obesity Drug From Shortages List
A trade group representing large compounding pharmacies has sued the U.S. Food and Drug Administration for a “reckless and arbitrary” decision to remove a widely prescribed Eli Lilly drug for combating diabetes and obesity from an official shortages list. The Outsourcing Facilities Association argued that a shortage of the drug, known as tirzepatide, actually still exists and the agency action was a coup for the company that came at the expense of the public. Moreover, the trade group maintained the FDA move was “unlawful,” because it failed to follow so-called rule-making procedures and provide proper notice of its plans. (Silverman, 10/8)
Modern Healthcare:
4 Nonprofit Health Systems Launch Longitude Health
Four large nonprofit health systems created a new company to use as a testing ground for boosting access to drugs, improved care coordination for Medicare Advantage patients and streamlined billing processes. Baylor Scott & White Health, Memorial Hermann Health System, Novant Health and Providence are the founding members of Longitude Health. Each health system has made an undisclosed financial commitment to fund Longitude, which is a Delaware-based holding company owned and managed by its founders. (Kacik, 10/8)
Also —
KFF Health News:
'An Arm and a Leg' Podcast: ‘Baby Steps’ In The Fight Against Facility Fees
An extra $99 fee on top of a copay for a checkup didn’t sit right with a listener. Turns out, state legislators across the country aren’t buying it either. (10/9)
