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Investing in products for individuals with complex medical needs has emerged as a key tactic for health insurers endeavoring to revive Medicare Advantage margins. Leading insurance companies pulled back slightly from Medicare Advantage for the coming plan year amid financial strains but are continuing a big push into the market for Dual-Eligible Special Needs Plans, or D-SNPs, which cover people who are eligible for both Medicare and Medicaid, according to analyses of preliminary data about the 2025 Medicare Advantage marketplace. (Berryman, 10/9)

�鶹Ů�� Health News: Employers Haven’t A Clue How Their Drug Benefits Are Managed

Most employers have little idea what the pharmacy benefit managers they hire do with the money they exchange for the medications used by their employees, according to a �鶹Ů�� survey released Wednesday morning. In �鶹Ů��’s latest employer health benefits survey, company officials were asked how much of the rebates collected from drugmakers by pharmacy benefit managers, or PBMs, is returned to them. (Allen, 10/9)

When former executives team up with an activist investor to “help” a struggling company, it is often bad news for the current chief executive. That is one implication behind activist investor Starboard Value’s $1 billion stake and its push to make changes at Pfizer, which The Wall Street Journal reported has support from former Pfizer Chief Executive Ian Read and former Chief Financial Officer Frank D’Amelio. Another important takeaway is that investors are eager to see a more disciplined and focused development strategy from the company. (Wainer, 10/8)

Michael Waters, chief operating officer of Teladoc Health, will leave his position at the end of the year. Waters will exit effective Dec. 31 in connection with a change in the executive reporting structure, according to a Sept. 27 Securities and Exchange Commission filing. He has served as Teladoc's COO since July 2022. (Desilva, 10/8)

A trade group representing large compounding pharmacies has sued the U.S. Food and Drug Administration for a “reckless and arbitrary” decision to remove a widely prescribed Eli Lilly drug for combating diabetes and obesity from an official shortages list. The Outsourcing Facilities Association argued that a shortage of the drug, known as tirzepatide, actually still exists and the agency action was a coup for the company that came at the expense of the public. Moreover, the trade group maintained the FDA move was “unlawful,” because it failed to follow so-called rule-making procedures and provide proper notice of its plans. (Silverman, 10/8)

Four large nonprofit health systems created a new company to use as a testing ground for boosting access to drugs, improved care coordination for Medicare Advantage patients and streamlined billing processes. Baylor Scott & White Health, Memorial Hermann Health System, Novant Health and Providence are the founding members of Longitude Health. Each health system has made an undisclosed financial commitment to fund Longitude, which is a Delaware-based holding company owned and managed by its founders. (Kacik, 10/8)

�鶹Ů�� Health News: 'An Arm and a Leg' Podcast: ‘Baby Steps’ In The Fight Against Facility Fees

An extra $99 fee on top of a copay for a checkup didn’t sit right with a listener. Turns out, state legislators across the country aren’t buying it either. (10/9)