68 pages. "What's New: [1] Changes to 'coverage month' definition for PTC/ APTC.... [2] Reporting entities no longer required to send minimum essential coverage (MEC) forms automatically."  MORE >>

"Understanding different types of benefits administration reports can help strengthen your benefits strategy. This blog covers ... [1] Seven benefits reports to consider, including plan enrollment, engagement and chronic condition management. [2] The data points to track for each report. [3] Understanding the purpose of each benefits report and how to use the data for plan optimization. [4] Why it's important to make data-driven benefits decisions."  MORE >>

"For those using GLP-1s to manage diabetes, medical cost growth was six percentage points lower than non-users at 30 months and nine percentage points lower for those with at least 80 percent adherence.... [F]emale GLP-1 users experienced approximately a 50 percent lower incidence of ovarian cancer and about a 14 percent lower incidence of breast cancer compared to female non-users over the study period.... The reduction in [major adverse cardiovascular events] for female users reached 47 percent, compared to 26 percent for male users, highlighting an even stronger cardiovascular benefit for women."  MORE >>

"For years, debate centered on 'spread pricing', the difference between what PBMs bill health plans and what they pay pharmacies. But this year, that narrow focus has widened. Regulators and lawmakers are looking deeper into how PBMs' ownership structures, reimbursement methods, and internal routing decisions shape the true cost of prescription drugs."  MORE >>

"Negotiations are slightly turning away from money and toward other aspects, such as ways to ways to reduce denials and ensure a faster turnaround on claims processing. Those discussions can be more constructive than haggling over dollars."  MORE >>

105 pages. "UHG provided ... over fifty thousand pages of documents.... This report presents the analysis of those documents ... [which] focused on how UHG has been able to maximize its risk adjustment scores and whether CMS's strategies to account for coding intensity at the MAOs can sufficiently counteract UHG's strategies. Staff discovered that UHG uses aggressive strategies to maximize these risk adjustment scores and that UHG appears to be able to leverage its size, degree of vertical integration, and data analytic capabilities to stay ahead of CMS's efforts to counteract unnecessary spending related to coding intensity. "  MORE >>

"A new Senate report alleges that UnitedHealth Group aggressively sought diagnoses that could increase its payouts in Medicare Advantage (MA).... The report also found that other MA organizations contract with UnitedHealth to capture diagnoses.... The report also notes that when [CMS] excluded some 8,000 codes from risk adjustment, UHG was able to deploy the capabilities necessary to identify new opportunities, and their efforts could be replicated by other MA organizations."  MORE >>

"With effectuation less than a year away for IPAY 2027 prices, the announcement of these MFPs will quickly flow into financial forecasts, formulary changes, and strategic market decisions. These prices are an indicator of how future negotiations may play out given deeper discounts achieved in this cycle. Navigating competitor dynamics and second-order impacts will be crucial to all stakeholders in the supply chain given the increasing interconnectedness of different markets, continually evolving Part D landscape, and the emphasis on transparency within the pharmaceutical supply chain."  MORE >>

"PTC opponents have pushed false claims to advocate against extending the enhancements. But as policymakers continue to negotiate an extension to help the millions of people who are seeing their premium costs spike, they should keep the realities of PTCs in mind."  MORE >>

"Despite the diversity of roles, many deskless jobs share common characteristics. They include limited access to cell phones and technology during the workday, irregular schedules and hours, and lack of a centralized office location.... [E]mployers can engage these deskless employees ... [by] collaborating with their benefits provider, using in-person communication, considering incentives, and leveraging frontline managers and influencers."  MORE >>