From The New York Times

UnitedHealthcare Will Expand a Drug Discount Program Aimed at Lowering Consumer Costs

March 12, 2019

The insurance giant UnitedHealthcare said Tuesday that it will expand a program that passes drug discounts directly to consumers, a move that could lower costs for many who have struggled with high deductible payments and other out-of-pocket expenses.

United said the plan would take effect next year and would be required for all new employer clients, although existing clients would be permitted to continue under the older system. Those clients will be “encouraged” to adopt the new plan when their contracts expire, but will not be required to do so, according to Matthew Stearns, a spokesman for OptumRx, the pharmacy benefit manager that is owned by United.

The insurance giant UnitedHealthcare said Tuesday that it will expand a program that passes drug discounts directly to consumers, a move that could lower costs for many who have struggled with high deductible payments and other out-of-pocket expenses.

United said the plan would take effect next year and would be required for all new employer clients, although existing clients would be permitted to continue under the older system. Those clients will be “encouraged” to adopt the new plan when their contracts expire, but will not be required to do so, according to Matthew Stearns, a spokesman for OptumRx, the pharmacy benefit manager that is owned by United.

Other insurers have offered employers the option to apply the after-the-fact discounts, called rebates, to consumers’ out-of-pocket expenses, but United appears to be the first major insurer to require it of new clients.

“This expanded point-of-sale discount program demonstrates our commitment to delivering better prices for consumers,” John Prince, the chief executive of OptumRx, said in a statement….

Read the full The New York Times article

Hospital Mergers Improve Health? Evidence Shows the Opposite

February 11, 2019

Many things affect your health. Genetics. Lifestyle. Modern medicine. The environment in which you live and work.

But although we rarely consider it, the degree of competition among health care organizations does so as well.

Markets for both hospitals and physicians have become more concentrated in recent years. Although higher prices are the consequences most often discussed, such consolidation can also result in worse health care. Studies show that rates of mortality and of major health setbacks grow when competition falls.

Many things affect your health. Genetics. Lifestyle. Modern medicine. The environment in which you live and work.

But although we rarely consider it, the degree of competition among health care organizations does so as well.

Markets for both hospitals and physicians have become more concentrated in recent years. Although higher prices are the consequences most often discussed, such consolidation can also result in worse health care. Studies show that rates of mortality and of major health setbacks grow when competition falls.

This runs counter to claims some in the health care industry have made in favor of mergers. By harnessing economies of scale and scope, they’ve argued, larger organizations can offer better care at lower costs….

Read the full The New York Times article

Trump Proposals Could Increase Health Costs for Consumers

January 21, 2019

Consumers who use expensive brand-name prescription drugs when cheaper alternatives are available could face higher costs under a new policy being proposed by the Trump administration.

The proposal, to be published this week in the Federal Register, would apply to health insurance plans sold under the Affordable Care Act.

Health plans have annual limits on consumers’ out-of-pocket costs. Under the proposal, insurers would not have to count the full amount of a consumer’s co-payment for a brand-name drug toward the annual limit on cost-sharing. Insurers would have to count only the smaller amount that would be charged for a generic version of the drug.

Consumers who use expensive brand-name prescription drugs when cheaper alternatives are available could face higher costs under a new policy being proposed by the Trump administration.

The proposal, to be published this week in the Federal Register, would apply to health insurance plans sold under the Affordable Care Act.

Health plans have annual limits on consumers’ out-of-pocket costs. Under the proposal, insurers would not have to count the full amount of a consumer’s co-payment for a brand-name drug toward the annual limit on cost-sharing. Insurers would have to count only the smaller amount that would be charged for a generic version of the drug.

For example, if a consumer filled a doctor’s prescription for a brand-name drug with a $25 co-payment, rather than using a generic medicine with a $5 co-payment, the consumer might get credit for only $5 in out-of-pocket spending. Consumers would have to spend more of their own money before reaching the annual limit on out-of-pocket costs….

Read the full The New York Times article

Court Blocks Trump Administration Restrictions on Birth Control

January 14, 2019

A federal court issued a nationwide injunction on Monday that prevents the Trump administration from interfering with women’s access to free birth control guaranteed under the Affordable Care Act.

The decision, by Judge Wendy Beetlestone of the Federal District Court in Philadelphia, extends a losing streak for President Trump, who has repeatedly been set back in his efforts to allow employers to deny insurance coverage of contraceptives to which the employers object on religious or moral grounds.

A federal court issued a nationwide injunction on Monday that prevents the Trump administration from interfering with women’s access to free birth control guaranteed under the Affordable Care Act.

The decision, by Judge Wendy Beetlestone of the Federal District Court in Philadelphia, extends a losing streak for President Trump, who has repeatedly been set back in his efforts to allow employers to deny insurance coverage of contraceptives to which the employers object on religious or moral grounds.

The rules were scheduled to take effect on Monday. The states of Pennsylvania and New Jersey challenged the rules before Judge Beetlestone, saying they would have to shoulder much of the burden of providing contraceptives to women who lost coverage under the Trump administration’s rules.

“The states’ harm is not merely speculative; it is actual and imminent,” Judge Beetlestone wrote. “The final rules estimate that at least 70,500 women will lose coverage….”

Read the full The New York Times article

Obamacare, Ruled Invalid by Federal Judge, Will Remain in Effect During Appeal

December 30, 2018

The federal judge in Texas who ruled this month that the entire Affordable Care Act was invalid issued a stay in the case on Sunday, meaning that the law will remain in effect while the ruling is appealed.

The judge, Reed O’Connor of the Federal District Court in Fort Worth, said that the ruling should not go into immediate effect “because many everyday Americans would otherwise face great uncertainty” during an appeal.

The federal judge in Texas who ruled this month that the entire Affordable Care Act was invalid issued a stay in the case on Sunday, meaning that the law will remain in effect while the ruling is appealed.

The judge, Reed O’Connor of the Federal District Court in Fort Worth, said that the ruling should not go into immediate effect “because many everyday Americans would otherwise face great uncertainty” during an appeal.

The ruling opened the door for an appeal by California and 15 other states that support the health care law.

Judge O’Connor’s original ruling had caused some confusion because it came as many states were finishing up open enrollment for 2019. Though he ruled that the law’s individual mandate was unconstitutional and that the rest of the law was therefore invalid, he did not issue an injunction stopping the law from being enforced….

Read the full The New York Times article