Consumer Directed Benefit Solutions

An informative read.

Anatomy of a Failed Moral Panic › American Greatness “Killer Agent Unmasked,” screamed a headline in The Drudge Report. I know, I know, hardly anyone sane reads the Drudge Report anymore. But its headline and accompanying stories did stake out the let’s…

More Than 500,000 Americans Set to Lose Their Medicare Advantage Plans Roughly 560,000 members will need to find a new plan.

MEDICARE ADVANTAGE ALERT - agents & brokers are just starting to get their early looks at what various Medicare Advantage & Medicare Part D Prescription plans will be doing for the 2025 plan year. The following was shared by a broker in Texas who attended Humana's meeting;

Just got off of the Humana First Look webinar. If you are in TX, be careful because they are moving some popular plans out of certain counties like Collin. They said this does create a GI Med Supp opportunity if the client wants it plus it is an opportunity to become AOR if a prior agent was with the prospect. I do not think they are mapping them over to a new plan, I think they will just get dropped. Not sure on that. Creates opportunity for all of the carriers that are dropping plans in certain counties and not putting them in another plan.

Every state's market will be unique but the overwhelming trend being seen is of some significant changes to carrier and plan availability as well as benefit and rate adjustments that can differ substantially from one county to the next within a state much less between them. MEDICARE ADVANTAGE ENROLLEES SHOULD BE LOOKING FOR THEIR ANNUAL NOTICE OF CHANGE LETTER FROM THEIR MEDICARE ADVANTAGE CARRIER THIS YEAR AND READING IT CAREFULLY.

As always, there is the law of unintended consequences to take into account, though I suspect that Big Pharma will do just fine.

Medicare price cuts may have unexpected side effects As the CMS celebrates drug price cuts, experts warn of unintended consequences for consumers and pharmacies.

How Narrow or Broad Are ACA Marketplace Physician Networks? - Report - 10455 | KFF One way insurers seek to control costs is to limit the size of the physician networks serving their plans. Providers agree to lower fees and other terms with insurers in order to be included in one or more of the networks they offer. Insurers then either limit coverage to services provided by networ...

For the eligible Medicare and Medicaid members of BC/BS of Tennessee that is, I believe this is the first large scale application of the "food is medicine" concept in public health programs in Tennessee.

Fresh produce deliveries are now a covered medical benefit in Tennessee FarmboxRx combats food insecurity and improves health outcomes by providing people with fresh produce deliveries.

2025 rate changes for ACA Marketplace health insurance plans in Tennessee, Mississippi, and Arkansas are quite moderate, with actions ranging from slight rate decreases to mid-single-digit increases.

How much and why ACA Marketplace premiums are going up in 2025 - Peterson-KFF Health System Tracker Health insurers submit rate filings annually to state regulators detailing expectations and rate changes for Affordable Care Act (ACA)-regulated health plans for the coming year. A relatively small, but growing, share of the population is enrolled in these plans (compared to the number in employer p...

FYI

Smoking & Va**ng Together Raise Lung Cancer Risks Even Higher FRIDAY, Aug. 2, 2024 (HealthDay News) -- Experts have long suspected it, but a new study confirms that folks who v**e and smoke to***co face higher risks for lu

It's not a good news day for Big Pharma as we have a second report regarding eye-popping price markups - in this case in the vaunted mail-order prescriptions arena. This is another example of an area where the original good intentions of a program/industry can morph into something different over time and without serious oversight.

Mail-order pharmacies add much bigger markups: Washington state groups For brand-name drugs, the average margin gap may be more than $65 per 30-day prescription.

When the pharmacy benefit management (PBM) industry began they were independent companies that added value in the purchasing and managing an increasingly complex prescription drug environment. Over the intervening years, most of these PBMs have been acquired and vertically integrated into health insurance companies where they became a rather uncontrolled profit pocket that is finally drawing some long overdue Federal scrutiny (but then it is an election year).

Big Pharmacy-Benefit Managers Increase Drug Costs, FTC Says Investigation finds firms, which are supposed to control spending, have overcharged for cancer drugs and taken other steps raising costs.