Facility Fees Blindsiding Patients

Facility fees are charged by hospitals and provider groups even when patients aren’t visiting the facility. Some states, including Connecticut and Colorado, have either already limited facility fees or are considering it. Hospitals argue that the fees are necessary to stay open as these fees typically help with the cost of imaging, and even some staff-related costs. Read more on our website.

Critics of the facility fees however counter that with record profits, limiting a facility fee, especially for telehealth visits is necessary to keep healthcare affordable. Facility fees don’t technically fall under the “No Surprises Act” even though it is often a surprise to the patient. High-deductible health plans are more likely to require patients to pay out of pocket for these fees.

Source: BenefitsPro.com

Elevance, Formerly Anthem, Reports Higher than Expected Earnings in Q1

In the first quarter of 2023, Elevance, formerly known as Anthem, posted a profit of $1.99 billion compared to $1.70 billion this time last year. Company officials attribute the increase to higher premium revenue from Medicare and Medicare Advantage, as well as increases in premium rates for Elevance health benefits. Additionally, Elevance had higher pharmacy product revenue from CarelonRX, its pharmacy benefit management (PBM) arm.

Overall revenue increased by 10.6%. Analysts had expected shares to increase to $9.26 for the first quarter, however, were surprised that the shares rose to $9.46 per share.

Sources: Morningstar.com & Associated Press

UnitedHealth Optum and Change Healthcare Merger in Jeopardy

A merger between healthcare insurance giant, UnitedHealth Optum and Change Healthcare is put in doubt due to a lawsuit by the Department of Justice. The DOJ contends that the merger would provide UnitedHealth with an unfair advantage in the insurance marketplace because of the data that Change Healthcare possesses.

Critics of the merger also point to the possibility of a monopoly on healthcare data. To counter, UnitedHealth Group said they already have access to competitor data and to misuse that data would be "economic suicide" for the group. UnitedHealth Group and Change Healthcare claim that the merger will simplify claims as well as administrative and payment processes which creates more efficiencies.

A trial is expected to start on August 1. We will keep you informed of these proceedings and the outcome.

Source: Fierce Healthcare

Pharmacy Deserts Commonplace

An estimated 40% of United States counties are considered “pharmacy deserts” according to research by GoodRx. These deserts affect black and Hispanic/Latino neighborhoods at higher rates. Pharmacy benefit managers (PBMs) play a significant role in pharmacy closures in the nation, however, factors including location, economic status, and vehicle ownership also help define a pharmacy desert.

When patients in an urban area live more than a mile from a pharmacy, they are considered to live in a pharmacy desert. Rural patients who live more than 10 miles from a pharmacy are in a desert, and suburban patients living two miles from a pharmacy are also in a pharmacy desert.

Pharmacy deserts are created when independent pharmacies that are close to patients are considered out-of-network, and patients have to pay significantly more for prescriptions. Patients, to save money, will travel farther to another in-network pharmacy, which over time, decreases the independent pharmacy’s overall sales. The pricing structure for reimbursement is also a factor. Up to 80% of pharmacies report that they are reimbursed for less than it costs to dispense medication.

Solutions for pharmacy deserts include more regulation of PBMs as well as a more equitable reimbursement system.

Source: HealthCare Brew

Express Scripts Unveils Copay Caps & Better Pricing Transparency

Express Scripts is unveiling new programs to help patients afford medication, but also make medication pricing more predictable. Express Scripts is a subsidiary of Cigna Evernorth.

Copay Assurance will cap the cost of drugs. Generic drugs will be capped at $5 for a month's supply; preferred brand-name drugs will be capped at $25 for a month's supply, and specialty drugs will be capped at $45 for one month.

The programs will take effect starting this summer.

Source: Fierce Healthcare

More Satisfaction Reported with Traditional Health Plans Over High-Deductible Health Plans

High-deductible health plans may save consumers money; however, they won’t be happy with them. A recent study revealed that only 47% of HDHP enrollees are satisfied with their health plan. Conversely, 57% of traditional plan enrollees were happy with their health plan. While higher out-of-pocket costs could contribute to dissatisfaction, there are other factors to consider. Read more on our website.

Lack of experience or education about their health plans could be another factor in dissatisfaction. This is especially true among those who are new to HDHPs. Satisfaction with HDHPs increases the longer the enrollee has had the plan according to the EBRI/Greenwald Research Consumer Engagement Center.

Source: BenefitsPro.com

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