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Morning Briefing

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Tuesday, Dec 3 2024

Full Issue

Even Negotiated Medicare Prices Of 10 Drugs Higher Than In Peer Nations

Researchers analyze the prices on drugs negotiated by Medicare, in comparison to what they cost in other countries. Other Medicare news relates to Medicare Advantage ratings, open enrollment, and veterans.

Prices for the first 10 drugs negotiated by Medicare fell from their initial net prices, but all drugs except one remained more expensive in the U.S. than in peer countries, researchers said. Compared with their net prices prior to negotiation, negotiated prices for the 10 drugs ranged from 8% lower for dapagliflozin (Farxiga) to 42% lower for sitagliptin (Januvia), reported Olivier J. Wouters, PhD, of the London School of Economics and Political Science, and co-authors. (Firth, 12/2)

UnitedHealthcare and Centene have received higher Medicare Advantage star ratings for the 2025 plan year after the Centers for Medicare and Medicaid Services revised their scores. On Monday, CMS published updated Medicare Advantage Star Ratings program data that reveal the agency increased the quality ratings for 12 UnitedHealthcare contracts and seven Centene contracts, each of which comprise multiple Medicare Advantage plans. CMS issued 2025 star ratings for all Medicare Advantage insurers in October. (Tepper and Broderick, 12/2)

Because some agents aren’t getting paid to sell certain Medicare Advantage policies, they may not recommend those plans even when they’re the best choices. (Eisenberg, 12/2)

Bruce Kitt is one of the Medicare Advantage industry’s most lucrative customers. The federal government pays his private Medicare Advantage insurer thousands of dollars a year to cover the cost of doctor visits, hospitalizations and other medical care that the 74-year-old retired aircraft mechanic might need. But Kitt, an Air Force veteran who served in Thailand during the Vietnam War, gets almost all of his healthcare outside the Medicare system, through the Minneapolis VA Medical Center. The taxpayer-funded Department of Veterans Affairs health system provides low-cost or free care to Kitt and about nine million other qualifying veterans. (Maremont, Weaver and McGinty, 12/2)

Also —

Dr. Oz has extolled Ozempic’s promise for weight-loss. Now Medicare, which Trump wants Oz to oversee, may cover it. (Butler, Weber and Gilbert, 12/2)

Medicare Advantage insurers thrived under the first Trump administration, and it’s expected to happen again now that Trump is returning to the White House and Republicans are taking control of Congress. The Medicare Advantage program is expected to cost taxpayers and beneficiaries more than $500 billion this year. For the past decade, it has been the insurance industry’s golden goose of profitability. But insurance companies have lamented recent regulations, worrying their margins will take a hit. (Herman, 12/3)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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