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The price hikes also tell us that drugmakers are taking steps to mitigate the impact of the government being able to negotiate drug prices in Medicare for the first time. Amid skyrocketing prescription drug spending in the US, government intervention led to the completion of the first round of price negotiations under the Inflation Reduction Act.

Medicare beneficiaries get access to RxPass. RxPass is Amazon Pharmacy’s prescription drug discount program for generic medications. It was launched in 2023 for Prime members but initially excluded Medicare. Now, Prime members in 46 US states who have Medicare insurance can access about 60 generic medications for a flat fee of $5 per month with no restrictions on the number of prescriptions.

It reimagined its health insurance strategy due to underwhelming performance in the Medicare Advantage (MA) space. As a whole, Aetna may finish the year operating at a loss—a remarkable downfall after generating nearly $5.6 billion in adjusted operating income for 2023. MA was the primary culprit, chiefly due to enrollees receiving more medical care than the company planned for.

The administration likely won’t meddle too much with Medicare drug price negotiations. But attempts to reign in D2C drug advertising as well as anti-vaccine rhetoric won’t go over well with Big Pharma. We’ll be closely monitoring the confirmations of Trump’s picks for key federal health agencies in early 2025.

The study focused on consumers with commercial health insurance since Medicare doesn’t cover GLP-1s exclusively for weight loss. What’s driving the news? GoodRx points to two separate but related factors driving consumers to spend more than they need to on GLP-1s. 1. Lack of insurance coverage. Most commercial insurance plans don’t cover GLP-1s for weight loss or impose coverage restrictions.

In October, a Senate panel released a report highlighting insurers’ refusal to pay for policyholders’ claims, in particular post-acute care for senior members on Medicare Advantage (MA) plans. The report found that under UnitedHealthcare’s prior authorization system, the denial rate for post-acute care rose to 22.7% in 2022, up from 10.9% in 2020.

We estimate that Medicare and Medicaid will spend over $424 billion on prescription drugs across all their programs this year. The RFK-led group will likely oppose the proposal and could instead push to allocate more federal dollars toward healthy food interventions for seniors and poor patients with obesity.

Will Trump take a tougher or weaker stance than Joe Biden on Medicare drug price negotiations? As part of Biden’s Inflation Reduction Act (IRA), the government was authorized to negotiate directly with pharmaceutical manufacturers to lower drug prices for Medicare for the first time. The final negotiated prices of the first 10 prescription drugs were released in August.

Should Kennedy become HHS secretary, he would oversee the federal public health system, Medicare and Medicaid policy, national healthcare research money, and food and drug regulation. This could hold serious implications for various corners of the healthcare ecosystem, with Big Pharma chief among them. Kennedy’s unorthodox views on vaccines could be bad news for pharma companies’ bottom lines.

The Inflation Reduction Act, if it continues under the Trump administration, is going to basically, in simple terms, lower profits for some pharmaceutical companies' drugs because instead of discharging whatever they want now for the first time for Medicare patients, the government will actually have a say in how much these drugs cost, which is I think a big positive.

The insurer continues to deal with persistent cost pressures in the Medicare Advantage (MA) market as MA enrollees receive more medical care than it anticipated. Aetna reported a medical benefit ratio of just over 95% in Q3, up from nearly 86% the same time last year.

Between 2022 and 2023, medical claim denials increased by an average of 20.2% for commercial plans and 55.7% for Medicare Advantage plans.

Aetna is dealing with continued cost pressures in the Medicare Advantage (MA) market as MA enrollees receive more medical care after delaying it during the pandemic. And there’s no light at the end of the tunnel. Aetna’s medical benefit ratio, a measure of how much a health plan spends on patient care, is expected to reach just over 95% in Q3, up from nearly 90% in Q2.

Amazon Pharmacy recently expanded its prescription drug discount program for generic medications, RxPass, to Prime members who are Medicare beneficiaries. Launched last year for Prime members, RxPass offers a limited number of generic drugs for a flat fee of $5 per month. Last year, Amazon Pharmacy lowered the cost of insulin to as low as $35/month, adding automatic coupons for shoppers.

The healthcare issues most important to voters: Healthcare costs and access are top-of-mind for consumers during this election cycle. 63% believe that a candidate’s position on protecting Medicare/Social Security is a very important healthcare issue that will determine their vote. A candidate’s position on lowering the cost of healthcare (57%) came in as a close second.

Highest among patients covered by Medicaid; lowest among Medicare patients and those with private insurance. Highest among consumers living in urban areas; lowest for suburban residents. Highest across Gen Yers and Gen Z consumers; lowest among seniors.

CVS’s insurance business, Aetna, is dealing with continued cost pressures in the Medicare Advantage (MA) market as MA enrollees receive more medical care after delaying it during the pandemic.

Humana analyzed data across six different SPCOs and over 462,000 patients enrolled in Medicare Advantage (MA) in 2021. For context, Humana operates a series of senior-focused primary care clinics across the US under the CenterWell Senior Primary Care brand name. Digging into the data: SPCOs served more Black and low-income beneficiaries than other primary care settings.

The surge was even more stark for Medicare Advantage (MA) plans, which experienced an average increase of 55.7%. Why it matters: The rise in denials dovetails with the adoption of AI tools by health insurers to approve or deny claims, much to patients’ chagrin.

The majority of US prescription drug spending comes from Medicare and Medicaid programs, which are not eligible for RxPass benefits. Medicare prescription drug spending will hit $292.6 billion (47.7% of the US total) in 2023. It will reach $356.4 billion (48.8% share) in 2026, we estimate.

Nonprofit FAIR Health searched its extensive database of private healthcare claims (which includes Medicare Advantage but excludes traditional Medicare, Medicaid, CHIP, and state and local claims) to find where PCPs and nonphysicians were dispensing primary care.

The data: Physicians bill an average of $3.8 million a year to commercial health insurers outside of Medicare or other government plans, per AMN Healthcare. AMN looked at claims submitted by physicians in 18 specialties, along with nurse practitioners (NPs) and certified registered nurse anesthetists (CRNAs).