Talking about what others are afraid to say
For decades, Medicare Advantage has been one of health care’s most profitable businesses. Millions of new members were coming online every year as baby boomers aged into Medicare. Enrollment grew …
Why Medicare Advantage Insurers Are Cutting Plans Read More
You might think not-for-profit health insurers have a lower claim denial rate, but 2024 research shows that’s not true. I pulled the latest CMS Transparency in Coverage data available for the …
How Nonprofit Insurers Compare in Claim Denials Read More
Employers have grumbled about rising prescription drug prices for years. They gripe about specialty-drug spending. They gripe about rebate dollars they can’t fully explain. They gripe about non-transparent contracts, formulary …
What If Employers Just Said Goodbye to PBMs? Read More
Pharma companies have had years to hone their arguments justifying sky-high drug prices. You know the speech. Innovation. Value. Breakthroughs. Unmet need. Transformative medicine. Patient access. But someone has to …
Thank You, Pharma: Your Drug Prices Are Helping Destroy the Employee Health Benefit Read More
It’s a story we hear every year. Health care costs are too high. Spending on prescription drugs is skyrocketing. Hospitals charge way too much. Employee utilization is out of control. …
Employers Need to Stop Complaining About Healthcare Costs—and Start Doing Something About Them Read More
If Walmart, Amazon, Apple, Microsoft, JPMorgan Chase and other massive employers can negotiate directly with suppliers for virtually everything else they purchase, why shouldn’t they negotiate directly with pharma companies …
America’s Largest Employers Should Form a Drug-Buying Alliance—and Bypass the PBMs Read More
There is no question that the FDA approval of Rasonque (daraxonrasib) represents an important advance for patients with metastatic pancreatic cancer. Its price should also trigger a serious discussion about how much …
$39,800 a Month for a Cancer Pill: When Does the Price of Innovation Become Too High? Read More
A new real-world study announced by Eli Lilly found that adults over age 55 with overweight or obesity who remained on Zepbound (tirzepatide) experienced lower healthcare costs over time compared …
Finally, Some Evidence Employers Can Use to Justify Covering GLP-1s Read More