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A closer look at how health care consolidation drives up patient costs, creates barriers to care

PhRMA

Half of every dollar spent on medicines goes to entities that don’t make medicine—like pharmacy benefit managers (PBMs) and insurers who are aggressively consolidating their control over health care and hospitals, clinics and for-profit pharmacies in the 340B markup program.

Insurance 263
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STAT+: Biden administration sticks with slight cuts to 2025 Medicare Advantage payments

STAT

Over the past few weeks, Medicare Advantage insurers demanded that the Biden administration give them higher payment rates for next year. The result: In 2025, right after a new president is elected, Medicare Advantage insurers will have to absorb a slight decrease of 0.2% Continue to STAT+ to read the full story…

Insurance 143
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STAT+: Biden administration ignores calls to bolster hospital price transparency

STAT

The federal government will not modify regulations that dictate how hospitals publish their prices for consumers, ignoring pleas from patient advocates who have said hospitals still are not fully complying with the 3-year-old law. The Biden administration on Wednesday proposed an annual rule that sets payment rates for hospitals.

Hospitals 108
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STAT+: Health care providers form a united front against stricter patient privacy rules

STAT

After yet another record year for health data breaches, updated federal security rules to protect patient information are on the table in 2025.

HIPAA 90
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STAT+: Why a big California employer ditched Elevance for some of its health plans

STAT

The California Public Employees’ Retirement System is making a drastic change to one of its major health insurance plans for the state’s employees and retirees: It’s switching health insurance carriers, and forcing its new partners to earn their fees instead of automatically getting them.

Insurance 100
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No one’s pleased with the government’s pitch for 2025 Medicare Advantage rates

STAT

But they could severely warp the economics of local markets for patients, employers, and insurers — and Lina Khan’s Federal Trade Commission is eager to make Big Physician a lot smaller. Read the rest…

Insurance 124
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New report sheds light on payment flows in the pharmaceutical supply chain, including the role of 340B and vertical integration

PhRMA

A new report explains the flow of dollars through the pharmaceutical supply chain for commercially insured patients taking retail medicines and details how transactions between stakeholders affect patient costs at the pharmacy counter.

Insurance 111