In 1971, President Nixon proposed a national health insurance plan built on heavily employer private coverage. Senator Ted Kennedy proposed what would today be called a single-payer plan. In 1974, the debate had morphed into Nixon vs. Kennedy-Mills vs. Organized labor. Despite the prediction in the second clip shown, the result was stalemate rather than passage in 1974 or 1975.
Fifty-seven percent of the U.S.’s managed Medicaid market is held by the top 10 Medicaid insurers, an analysis from a Washington, D.C., publishing and information company Atlantic Information Services found.
AIS’ Medicare and Medicaid market data found four of the top 10 payers are involved in mergers and acquisitions that may allow them to gain more market share. Specifically, Hartford, Conn.-based Aenta’s proposed acquisition of Louisville, Ky.-based Humana would allocate more than 400,000 Medicaid beneficiaries to Aetna, if the deal is not blocked by the U.S. Department of Justice. In addition, the third ranked insurer, St. Louis-based Centene, acquired Woodland Hills, Calif.-based Health Net in July, leaving the resulting entity with the highest market share.
Here are the top 10 insurers with the most Medicaid beneficiaries and market share.
Prime Therapeutics deal would integrate pharmacy, Blue plan.
Eagan-based Prime Therapeutics has formed a strategic alliance with drugstore giant Walgreens that would combine the companies’ specialty and mail-order pharmacy businesses.
In addition, health plan subscribers with pharmacy benefits managed by Prime Therapeutics would have preferred access to Walgreens pharmacies as part of the agreement announced Monday.
Financial terms were not disclosed, but Prime officials believe it could spur growth that pushes the firm beyond its position as the country’s fourth-largest pharmaceutical benefits manager (PBM).
Prime Therapeutics is owned by 14 Blue Cross and Blue Shield insurance companies, so the agreement with Walgreens brings together two of the country’s strongest brands in health care, said Jim DuCharme, the chief executive of Prime Therapeutics, in an interview.
“Nobody in the industry has integrated and connected the health plan — the Blue plan — with the retail pharmacy network, with the PBM, for unification of data, technology and overall drug cost reduction,” DuCharme said. “So, that’s probably the most unique feature of this strategic alliance.”
Health insurers hire PBMs to manage the pharmacy benefit portion of health plans. That means everything from negotiating prices with drug companies to structuring formularies that stipulate patient co-payments for different medications.
PBMs assemble a network of retail pharmacies where health plan subscribers can get their prescriptions at the lowest cost. The companies also directly fill prescriptions for patients through mail-order pharmacies as well as specialty pharmacies focused on high-cost and complex medications.
http://www.healthcaredive.com/news/uwe-reinhardt-adverse-risk-selection-crippling-obamacare/425182/
http://www.fiercehealthcare.com/payer/obamacare-ceo-kevin-counihan-counterstrikes-aetna-s-aca-exit
In the aftermath of Aetna’s ACA exchange exit, which leaves places like Pinal County, Arizona, with no insurers scheduled to offer plans in 2017, Obamacare CEO Kevin Counihan says HHS has already revved up its efforts to recruit insurers to fill in the gaps, according to an interview with Politico.
Insurers, including most recently the Dallas-based insurer Scott & White Health Plan, say sicker, more expensive populations mean they’re losing money on government-created marketplaces. Aetna, Scott & White, UnitedHealth and Humana have all said they can’t afford to keep offering the plans.
This week, Aetna dropped out of 68 percent of the exchanges in which it was operating.
But the insurance market–a market based in risk, after all–will always be dynamic. That was the case even before healthcare reform. “This is the nature of the industry,” Counihan toldPolitico.
According to University of Chicago economist Robert Kaestner, these exits are entirely normal.
“I don’t think it’s a particularly unusual situation where the firms are leaving the market,” Kaestner told Salon. “The fact that firms can leave and enter markets means the markets are, in fact, quite competitive.”
Three out of four medicines with $1 billion or more of yearly global sales increased prices by more than double the rate of inflation between 2009 and 2015, even when insurer- and pharmacy benefit manager-negotiated discounts were factored in, a Bloomberg analysis shows.
Insurers can easily require patients to switch to alternatives, the analysis notes, giving them leverage to negotiate lower prices.
But drug costs are still putting significant pressure on payers’ margins, rising from less than 10 percent of care-cost expenditures years ago to 13 percent in 2010 and 17 percent in 2015. Insurers and state lawmakers have tried pushing back, with Virginia among severalstates trying to legislate better price transparency. Insurers also are experimenting with negotiating deals with drug manufacturers that link prices to how well the drugs work.
Bloomberg looked at 39 drugs for its analysis. Only six increased in price at the rate of inflation or below, the news agency found. Discounted prices rose significantly as well. The discounted prices for 27 of the 39 drugs rose by 25 percent or more over six years; the consumer price index rose just 9.5 percent during the same period, according to the article. Prices doubled or more for seven drugs.
Healthcare insurance companies are actively fighting to keep drug costs low for their members and for their own bottom lines. Now a new policy brief offers state policymakers tips on how to shift more of the costs to payers in an effort to protect consumers.
The brief (.pdf) from the National Association of Insurance Commissioners outlines several regulations policymakers can adopt to ease consumers’ cost burdens, including:
HENRY KOTULA 