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Big MLR Rebates Point to Ever-More-Profitable ACA Exchanges

"CMS revealed that private health plans had to deliver $2 billion in rebates to their customers for the 2020 reporting year, with the bulk of that money going toward individual market enrollees. [ACA] experts say that while the large rebate payout does mean premiums have been overpriced, it's also indicative of just how profitable the ACA exchanges have become for insurers."

Payers, Plan Sponsors Hope for 2022 Telehealth, Drug Price Laws

"Carriers and plan sponsors are taking stock of what federal policies deserve a fresh look as they work though tumultuous events like the pandemic and the telehealth boom. In the next year, major industry trade groups plan to push for policies including drug price reform and comprehensive telehealth regulation."

Health Insurers Embrace Vaccine Requirements for Workers

"Although the Biden administration's vaccine mandates are meeting resistance in the federal courts, many health care firms -- including insurers -- appear to be requiring their employees to get COVID-19 vaccinations anyway.... 47% of health care organizations polled said they had a vaccine requirement in place already, compared to just 18% of employers overall."

Big Box Stores Add In-House Health Clinics, Directly Woo Health Plans

"While storefront clinics aren't new, especially in big box stores, health care insiders say the emphasis on selling to plans over consumers is novel, and that health plans may come to see such agreements as an essential benefit."

Amazon Plans to Offer 6-Month, Discount Generic Rx Fills

"Amazon.com, Inc. launched a long-anticipated expansion of its pharmacy business on June 8, saying it will allow Prime members to purchase up to six-month supplies of generic prescription drugs for $6.... Amazon's well-developed logistics and internet retail abilities mean it will be a formidable player."

2020 in Review: PBMs Continue Integration, Face More Regulatory Challenges

"The PBM space has consolidated to the point that five firms ... manage the lion's share of the pharmacy benefits offered to U.S. health plan members. Beyond their deepening integration with the payers that own them, these firms are working to expand their data and direct-to-consumer operations."

Insurer-Affiliated PBMs Propel Parent Firms' Revenues in Third Quarter

"Large insurer-affiliated PBMs saw strong results for the third quarter of 2020, in several cases driving revenues for parent companies that are grappling with various disruptive effects of the coronavirus pandemic. At CVS Health Corp., ... total revenues increased 3.5% year over year to $67 billion, and the company posted earnings per share (EPS) of $1.66, beating analysts' estimates.... Evernorth helped to boost Cigna's overall revenues to $40.8 billion ... Revenues for the Evernorth segment were $29.83 billion, a 20% increase year over year."

California Passes Law to Expand Behavioral Health Reimbursement Parity

"Plans will be required to base their decisions about medical necessity on evidence-based standards developed by nonprofit professional associations like the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Previously, plans were only required to provide coverage at parity for nine behavioral health disorders."

Some Insurers End Broad Telehealth Cost-Sharing Waivers

"For its members in fully insured commercial plans, Aetna will continue waiving cost sharing for virtual and in-person coronavirus-related diagnosis and treatment through Dec. 31. But its previous policy of waiving fees for all types of telehealth visits ended as of June 4... For members of Anthem's individual market or fully insured employer plans, waived cost sharing for non-coronavirus-related telehealth ended Sept. 30.... UnitedHealthcare says ... that for its individual and fully insured group health plan members, 'there is $0 cost-share for non-COVID-19 related telehealth visits with network providers through Sept. 30, 2020. After that date, members will be responsible for any copay, coinsurance and deductible, according to their benefits plan.' "

Insurers Welcome Changes to Addiction Treatment Privacy Rules

"A recent federal proposal — which would loosen privacy rules surrounding substance use disorder (SUD) treatment — is being applauded by health insurer trade groups. But some advocates are worried about potential harms to patients."