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CVS Plans to Overhaul How Much Drugs Cost
  + stars: | 2023-12-05 | by ( Anna Wilde Mathews | ) www.wsj.com   time to read: 1 min
Pharmacies currently are paid using complex measures that aren’t directly based on money spent to purchase specific drugs. Photo: Stephanie Keith/Bloomberg NewsCVS Health , the nation’s largest drugstore chain, will move away from the complex formulas used to set the prices of the prescription drugs it sells, shifting to a simpler model that could upend how American pharmacies are paid. Under the plan, CVS’s roughly 9,500 retail pharmacies will get reimbursed by pharmacy-benefit managers and other payers based on the amount that CVS paid for the drugs, in addition to a limited markup and a flat fee to cover the services involved in handling and dispensing the prescriptions. Today, pharmacies are generally paid using complex measures that aren’t directly based on what they spent to purchase specific drugs.
Persons: Stephanie Keith Organizations: Bloomberg, CVS Health
A tie-up between Cigna and Humana would breathe new life into the M&A market. Photo: Joe Buglewicz/Bloomberg NewsCigna and Humana are in talks for a combination that would create a new powerhouse in the health-insurance industry. The companies are discussing a stock-and-cash deal that could be finalized by the end of the year, assuming the talks don’t fall apart, according to people familiar with the matter.
Persons: Joe Buglewicz Organizations: Bloomberg Locations: Cigna
Average annual contributions to premiums For single coverage For family coverage $23,968 total $25,000 $25,000 Worker contribution Employer contribution 20,000 20,000 15,000 15,000 $6,575 worker share $8,435 total 10,000 10,000 5,000 5,000 $1,401 worker share 0 0 2000 '05 '10 '15 '20 2000 '10 '20 Average annual contributions to premiums For single coverage For family coverage $23,968 total $25,000 $25,000 Worker contribution Employer contribution 20,000 20,000 15,000 15,000 $6,575 worker share $8,435 total 10,000 10,000 5,000 5,000 $1,401 worker share 0 0 2000 '05 '10 '15 '20 2000 '10 '20 Average annual contributions to premiums Worker contribution Employer contribution For single coverage $8,435 total $10,000 5,000 $1,401 worker share 0 2000 '05 '10 '15 '20 For family coverage $23,968 total $25,000 20,000 15,000 $6,575 worker share 10,000 5,000 0 2000 '10 '20 Average annual contributions to premiums Worker contribution Employer contribution For single coverage $8,435 total $10,000 5,000 $1,401 worker share 0 2000 '05 '10 '15 '20 For family coverage $23,968 total $25,000 20,000 15,000 $6,575 worker share 10,000 5,000 0 2000 '10 '20Inflation came for your healthcare this year. Next year is looking to be just as bad. The cost of employer health insurance rose this year at the fastest clip since 2011, according to an annual survey from KFF, a healthcare research nonprofit. The 7% jump in the cost of a family plan brought the average tab to nearly $24,000—more than the price for some small cars.
Locations: KFF
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit www.djreprints.com. https://www.wsj.com/health/pharmacy-giant-walgreens-names-new-ceo-22b665d8
Persons: Dow Jones, 22b665d8 Organizations: walgreens
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit www.djreprints.com. https://www.wsj.com/health/healthcare/these-employers-took-on-healthcare-costs-and-the-fight-got-nasty-54674114
Persons: Dow Jones
The Pharmacy-Benefit Sector Just Took a Hit
  + stars: | 2023-08-18 | by ( Anna Wilde Mathews | ) www.wsj.com   time to read: 1 min
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit www.djreprints.com. https://www.wsj.com/health/healthcare/the-pharmacy-benefit-sector-just-took-a-hit-f1c353cc
Persons: Dow Jones
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit www.djreprints.com. https://www.wsj.com/health/healthcare/a-big-health-insurer-is-ripping-up-the-playbook-on-drug-pricing-ec152227
Persons: Dow Jones
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit www.djreprints.com. https://www.wsj.com/articles/unitedhealth-unh-q2-earnings-report-2023-2361e546
Persons: Dow Jones
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit www.djreprints.com. https://www.wsj.com/articles/cvs-caremark-delays-block-customers-from-their-prescriptions-f36ff60
Persons: Dow Jones
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit www.djreprints.com. https://www.wsj.com/articles/your-health-insurance-is-giving-you-trouble-heres-how-to-fight-back-103c4fb7
Persons: Dow Jones
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit www.djreprints.com. https://www.wsj.com/articles/your-health-insurance-is-giving-you-trouble-heres-how-to-fight-back-103c4fb7
Persons: Dow Jones
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit www.djreprints.com. https://www.wsj.com/articles/workers-want-ozempic-for-weight-loss-few-employers-want-to-pay-for-it-215fb5c1
This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit www.djreprints.com. https://www.wsj.com/articles/workers-want-ozempic-for-weight-loss-few-employers-want-to-pay-for-it-215fb5c1
How to Get Insurers to Pay for Ozempic and Other Weight-Loss Drugs Ozempic and other weight-loss drugs can list at $900 or more per month. WSJ’s Anna Wilde Mathews joins host J.R. Whalen to discuss how to get your health insurance plan to cover these prescriptions.
If you want to take one of the buzzy drugs like Ozempic or Wegovy to lose weight, the toughest part may be finding a way to pay for it. Insurers and employers, fearing the cost of medications that list for $900 or more a month, often put up hurdles when patients seek access to one of the drugs to slim down. Yet there are ways to get your health plan to pay for your prescription, if you qualify—and some alternatives if you don’t.
Kaiser Permanente has long been a bellwether for uniting different healthcare functions. Photo: Mike Blake/REUTERSKaiser Permanente, a pioneering integrated health system based on the West Coast, has agreed to acquire a Pennsylvania-based hospital operator in a bid to create a new national player in the rapidly consolidating healthcare market. The combination of Kaiser and Geisinger, which must be reviewed by federal and state agencies, would have more than $100 billion in revenue.
The new plan will eliminate or trim the payments associated with some health conditions. The Biden administration will move ahead with changes that could reduce federal payments to many private Medicare plans, but will phase them in more slowly than it had planned under an earlier proposal that drew huge pushback from the industry. The final payment policy for the private Medicare plans, known as Medicare Advantage, was released Friday and will take effect next year. The rollout of the changes, which will now take place over three years rather than one, means that the effect in 2024 will be substantially less than under the earlier proposal.
UnitedHealthcare said it would cut its use of the prior authorization process. The paperwork required by health insurers to get many medical procedures or tests—one of the biggest gripes of doctors and patients—is getting rolled back. UnitedHealth Group Inc.’s UnitedHealthcare, the largest health insurer in the U.S., said it would cut its use of the prior authorization process. Starting in the third quarter, it will remove many procedures and medical devices from its list requiring the signoff.
Mark Bertolini said he would initially focus on ensuring Oscar meets its goal of having profitable insurance business this year. Mark Bertolini , former chief executive of health insurance giant Aetna Inc. and hedge fund Bridgewater Associates, will take the helm of Oscar Health Inc. as it seeks to turn a profit and carve out a role as a technology supplier in the healthcare industry. Mr. Bertolini, 66 years old, will take the post effective next Monday, the company said. He will succeed Mario Schlosser , 44, who co-founded Oscar in 2012 with Joshua Kushner and will take the new title of president of technology, reporting to Mr. Bertolini.
Health insurers are tussling with the Biden administration over a proposal that could curtail federal payments for some private Medicare plans, a high-stakes issue for the industry because the business represents a growth engine. In a continuing effort that included a Super Bowl ad, insurers and their allies argue that the administration plans a payment cut next year for the popular health plans, which are known as Medicare Advantage. The tagline for the commercial, from the industry-backed Better Medicare Alliance, was “Tell the White House: Don’t cut Medicare Advantage.” The group has also rallied Medicare Advantage enrollees to call members of Congress, and it has set up a site at dontcutmedicareadvantage.com.
Humana Exits Employer Insurance Business
  + stars: | 2023-02-23 | by ( Will Feuer | Anna Wilde Mathews | ) www.wsj.com   time to read: 1 min
Humana’s departure from its Employer Group Commercial Medical Products business will happen over the next 18 to 24 months. Humana Inc. said it would exit its Employer Group Commercial Medical Products business, including all fully insured, self-funded and federal employee health benefit medical plans. The health-insurance company said the move comes after a strategic review that determined the business was no longer positioned to sustainably meet the needs of customers or to support Humana’s long-term strategic plans.
CVS Health Corp. agreed to acquire Oak Street Health Inc. for about $10.6 billion including debt, in the latest sign of the growing tie-ups between health insurers and primary-care doctors. The all-cash deal, for $39 a share, is expected to close in 2023, the companies said Wednesday. The Wall Street Journal reported Monday the companies were nearing a deal.
CVS, the parent of its namesake pharmacies, is seeking to move deeper into the direct provision of healthcare. CVS Health Corp. is close to an agreement to acquire Oak Street Health Inc. for about $10.5 billion including debt, a deal that would rapidly expand the big healthcare company’s footprint of primary-care doctors with a large network of senior-focused clinics, according to people with knowledge of the matter. The companies are discussing a price of about $39 a share, the people said. The deal, if it goes through, could be announced as soon as this week, they said. CVS is scheduled to report earnings on Wednesday.
Elevance Health Inc. reported higher revenue but a smaller profit for the fourth quarter as premiums rose in tandem with medical costs. The health insurer and healthcare-services provider, formerly known as Anthem Inc., said Wednesday that total revenue increased 9.2% to $39.93 billion, topping analyst expectations of $39.77 billion, according to FactSet.
The new rule could prompt Medicare to seek to recover billions of dollars in alleged overpayments from insurers. Federal health regulators said they would implement a tough new standard for auditing the billings of insurers that offer private Medicare plans, the latest sign of stepped-up scrutiny of the companies. Yet the new rule, set to be issued Monday by Medicare’s parent agency, doesn’t go as far as it could have in applying the standard to earlier years.
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