Medicare beneficiaries who take a lot of pricey medications will get a big break in 2025. That's when the $2,000 annual cap on out-of-pocket costs for drugs bought at the pharmacy or through mail order takes effect. The limit is one of the 2022 Inflation Reduction Act's most consequential provisions to lower prescription drug prices for Medicare enrollees. The law also instituted a $35 monthly cap on insulin prescriptions, enabled beneficiaries to get more vaccines at no cost, allowed Medicare to negotiate the prices of certain medications and required drug makers to pay a rebate to Medicare if they hike prices faster than inflation. Before the law, there was no cap on what Medicare enrollees might have to spend on medications covered by their Part D drug plans. They were on the hook for 5% of their drugs' cost in the so-called catastrophic coverage phase, which, in 2023, began when they hit $7,400 in out-of-pocket spending. The federal government paid 80% of the cost, while insurers paid 15%.
A deal reached Monday afternoon will prevent any disruptions in care for some patients of Ohio State University's medical facilities. Ohio State University Wexner Medical Center announced the multi-year deal Monday afternoon with Anthem Blue Cross and Blue Shield. The deal allows more than 110,000 people to continue to receive care through Ohio State University's medical facilities, including the Ohio State University Comprehensive Cancer Center, at in-network rates. A previous deal between the insurance company and the medical facility had been set to expire at the end of the year.
An outpouring of public rage against health insurers in the wake of the killing of a top UnitedHealth Group executive has drawn scrutiny to the country's largest healthcare company. UnitedHealth recorded $372 billion in revenue last year—making it about the same size as Apple. It owns the biggest U.S. health insurer, and has expanded into almost every corner of the medical field. The company was founded in Minnesota in the 1970s. Its growth came in part through scores of acquisitions, some with price tags that were never made public. The company has confronted and mostly overcome antitrust challenges to its influence over healthcare markets. UnitedHealth said the company accounts for less than 10% of a "highly fragmented and competitive healthcare market," and that "fragmentation is a core problem for patients and providers, diminishing outcomes, quality and affordability, and our approach is intended to make healthcare work better for all."
Most Americans believe health insurance profits and coverage denials share responsibility for the killing of UnitedHealthcare's CEO — although not as much as the person who pulled the trigger, according to a new poll. In the survey from NORC at the University of Chicago, about 8 in 10 U.S. adults say the person who committed the killing has "a great deal" or "a moderate amount" of responsibility for the Dec. 4 shooting of Brian Thompson. About 7 in 10 adults say that denials for healthcare coverage by insurance companies, or the profits made by health insurance companies, also bear at least "a moderate amount" of responsibility for Thompson's death. Despite that, some have cast Luigi Mangione, the 26-year-old suspect charged with Thompson's murder, as a heroic figure in the aftermath of his arrest, which gave rise to an outpouring of grievances about insurance companies.
UnitedHealth and Amedisys have agreed to extend the deadline to close their $3.3 billion merger agreement to next year, a filing showed on Friday, as the deal faces close scrutiny from the DOJ. The extension comes more than a month after the DOJ and three U.S. states filed a lawsuit to block the deal, citing concerns that it would reduce competition in the home health services market.
Patients examined by doctors working for UnitedHealth, an industry pioneer in directly employing large numbers of physicians, had some of the biggest increases in sickness scores after moving from traditional Medicare to the company's plans, according to the Journal’s analysis of Medicare data between 2019 and 2022. Sickness scores for those UnitedHealth patients increased 55%, on average, in their first year in the plans, the analysis showed. That increase was roughly equivalent to every patient getting newly diagnosed with HIV, the virus that causes AIDS, and breast cancer, the analysis showed. That far outpaced the 7% year-over-year rise in the sickness scores of patients who stayed in traditional Medicare, according to the analysis. Across Medicare Advantage plans run by all insurers, including UnitedHealth, scores for all newly enrolled patients rose by 30% in the first year. A spokesman for UnitedHealth said in a written statement that the company’s practices lead to "more accurate diagnoses, greater availability of care and better health outcomes and prevention, including less hospitalization, more cancer screenings and better chronic disease management." The company’s approach, he said, helped to avert more serious health problems later, and to achieve Medicare Advantage’s goals of improving quality and reducing costs.