Daily Industry Report - February 16

Your summary of the Voluntary and Healthcare Industry’s most relevant and breaking news; brought to you by the Health & Voluntary Benefits Association®

Jake Velie, CPT
Vice Chairman, President & COO
Health & Voluntary Benefits Association® (HVBA)
Daily Industry Report (DIR)

Robert S. Shestack, CCSS, CVBS, CFF
Chairman & CEO
Health & Voluntary Benefits Association® (HVBA)
Daily Industry Report (DIR)

HHS, FTC want to know if GPOs, drug wholesalers are fueling generic drug shortages

By Dave Muoio - The Biden administration is taking a look at how group purchasing organizations (GPOs) and drug wholesalers are playing a role in generic drug shortages. Read Full Article…

VBA Article Summary

  1. Joint Request for Information on Drug Market Dynamics: The Federal Trade Commission (FTC) and the Department of Health and Human Services (HHS) issued a Request for Information to explore the market concentration, contracting practices, and regulatory exemptions of organizations within the pharmaceutical industry. This inquiry aims to identify any factors that may discourage competition among generic drug suppliers, the effects of limited competition between Group Purchasing Organizations (GPOs) and drug wholesalers on patients, pharmacies, and providers (especially those in rural or smaller settings), and the causes behind persistent generic drug shortages.

  2. Impact of Healthcare Monopolies on Patients: HHS Secretary Xavier Becerra highlighted the real-world consequences of these market dynamics, particularly the scarcity of essential generic medications for conditions such as ADHD and cancer. This situation underscores the Biden-Harris Administration's commitment to addressing healthcare monopolies and mitigating their impact on vulnerable populations who suffer most from the lack of competition. The investigation into GPOs and drug wholesalers, both key intermediaries in the supply chain, is part of broader efforts to promote transparency and ensure a steady supply of critical medications.

  3. Public and Industry Engagement for Solutions: The FTC and HHS are soliciting public input through a detailed 17-point Request for Information, allowing 60 days for comments, documents, and data submission. This call to action encourages stakeholders, including advocacy groups, to share insights on the negotiating power of GPOs and drug wholesalers, the effects of sole-source agreements, and suggestions for enhancing the resilience of the drug supply chain. FTC Chair Lina M. Khan emphasized the importance of understanding the factors leading to drug shortages and examining the role of "opaque drug middlemen" in this context, signaling a readiness to explore regulatory and policy measures to address these challenges comprehensively.

HVBA Poll Question - Please share your insights

Would you advise clients to import specialty or high cost brand drugs like Ozempic, Mounjaro, Wegovy from abroad to save 35-50% off U.S. prices of $850, $1,070, $1,670 per month respectively?

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Our last poll results are in!


of Daily Industry Report readers who responded to our last polling question think Eli Lilly’s direct-to-consumer website for Telehealth prescriptions and drug delivery, feel this will somewhat positively affect patient access and disrupt the traditional drug supply chain.

24.03% of respondents are neutral or uncertain, 22.79% feel it will negatively affect patient access and have minimal or adverse effects on the supply chain while 16.61% are highly positive this will affect and and improve patient access and disrupt the traditional supply chain.

Have a poll question you’d like to suggest? Let us know!

Despite Price Transparency Laws, Americans Are Nowhere Near Able to Shop for Care. How Can This Change?

By Katie Adams - Less than one-fifth of U.S. adults know the cost of their healthcare products and services prior to receiving them, according to the results of a new Gallup poll. The results were released this month — more than three years after CMS began enforcing its price transparency rule for hospitals, and more than a year after payers were also required to publicly disclose their rates. Read Full Article…

VBA Article Summary

  1. Initial Steps and Compliance Improvements: Since the CMS price transparency legislation took effect, there has been significant progress in making healthcare pricing data available, though it's still challenging for consumers to easily understand and use this information. Marcus Dorstel of Turquoise Health highlighted the widespread compliance among hospitals and payers with CMS' requirements, a shift driven by stricter fines for noncompliance and the desire of hospitals to accurately represent themselves. This compliance is seen as the first step towards creating a more transparent healthcare pricing environment, aiming to facilitate better business decisions and contract negotiations within the industry based on accessible and accurate data.

  2. The Role of Technology in Price Transparency: The legislation's intent goes beyond just informing consumers; it seeks to leverage technology to clean and simplify the complex data for easier consumer understanding and use. Amanda Eisel of Zelis emphasized the government's vision of enabling tech companies to develop tools that help consumers navigate healthcare pricing effectively. Despite the current raw and complex nature of the data, there's an expectation that, with time, software developers will create innovative solutions that aggregate and personalize pricing information, making it genuinely useful for consumers.

  3. Future Developments and Employer Involvement: Experts agree that while the foundation for price transparency has been laid, there's still a considerable journey ahead before the data becomes truly impactful for the average American. The development of consumer-friendly tools by health tech companies is crucial, requiring a focus on episodes of care, personalization, and the translation of medical jargon into understandable language. Additionally, employers are seen as key players in increasing awareness and trust in price transparency data. By actively engaging employees with resources and tools, employers can significantly contribute to enhancing the utility of price transparency in healthcare decision-making.

Humana to shutter Louisville, Kentucky headquarters; top executives now working out of Washington, D.C.

By Wendell Potter - As many of you know, I started my career in the corporate health insurance business at Humana in 1989. I worked in the company’s 27-story pink granite tower, designed by renowned architect Michael Graves and overlooking the Ohio River in downtown Louisville. The building was just four years old at the time, and it demanded attention. To this day, it is still one the tallest and most striking buildings in the state. Read Full Article…

VBA Article Summary

  1. Impressive Corporate Culture and Personal Encounters: The article recounts the author's experiences at Humana, starting with their awe at the art collection including Giacometti sculptures and a Paul Klee painting, owned by Humana president Wendell Cherry. The narrative sets a scene of opulence within the corporate environment, including a high-end gym. The author's interactions with top executives like CFO Carl Pollard, known for his distinctive full-length fur coat and blunt demeanor, illustrate the unique corporate culture and personal dynamics within Humana.

  2. Career Growth Amidst Company Evolution: Despite initial challenges and the CFO's skepticism towards the public affairs department, the author advanced within Humana, handling crisis communications and managing significant company transitions, such as Humana's pivot from hospital ownership to focusing on health insurance for seniors. This period of transformation underscores the company's adaptability and the author's ability to navigate and contribute to its evolution, culminating in a leadership position in communications.

  3. Corporate Shifts and Financial Struggles: The article highlights Humana's recent challenges, including the decision to relocate from its iconic "pink palace" as part of cost-cutting efforts to appease unhappy shareholders. This move reflects broader strategic shifts, with many executives working from Washington D.C. to stay close to government business critical to Humana's revenue. Despite these efforts, Humana faces financial difficulties, underscored by significant losses in the fourth quarter of 2023 due to higher than expected Medicare Advantage enrollee healthcare use, leading to a substantial drop in stock price and shareholder value. These developments signal a critical juncture for Humana amidst intense scrutiny of Medicare Advantage plans and their financial implications.

Financial Woes, Care Delays More Common Among Adults with Medical Debt

By Victoria Bailey - Adults with medical debt are more likely to delay care and experience additional financial challenges compared to those without debt, according to a KFF analysis. The analysis used data from the 2021 National Financial Capabilities Survey (NFCS), which provides information on the financial security, experiences, and vulnerabilities of individuals and households. Read Full Article…

VBA Article Summary

  1. Prevalence and Impact of Medical Debt: In 2021, 23% of U.S. adults had medical debt, with figures slightly increasing to 24% according to KFF’s 2022 Health Care Debt Survey. A significant 41% of adults carried healthcare debt, including amounts charged on credit cards or borrowed from family. Those with medical debt often face financial vulnerabilities, such as lacking a rainy-day fund (68%) and experiencing a significant income drop (50%), compared to their debt-free counterparts.

  2. Financial Behaviors and Challenges: Individuals with medical debt are more likely to have poor credit perceptions, struggle to save, and frequently face financial strains at the month's end. They are more prone to incurring credit card charges, late fees, and debt collection activities, with 55% having been contacted by debt collectors. High-risk borrowing, such as using pawn shops or payday loans, is notably higher among those with medical debt, exacerbating their financial stress.

  3. Healthcare Access and Care Avoidance: Medical debt significantly affects healthcare access, with 46% of indebted individuals avoiding doctor visits and 42% skipping recommended tests or treatments due to cost concerns. This issue persists across insured and uninsured groups, highlighting that high cost-sharing and inadequate coverage contribute to the deferment of necessary medical care. The overall financial instability driven by medical debt leads to postponed care, underscoring the need for addressing both the symptoms and root causes of medical debt to improve health outcomes and financial well-being.

Independent doctors like me are becoming an endangered species

By Paul Berggreen - More than 100,000 doctors have left private practice and become employees of hospitals and other corporate entities since 2019. Today, nearly three in four physicians are employees of larger health care entities or other corporations — a record high. Read Full Article…

VBA Article Summary

  1. Challenges and Adaptation of Independent Physicians: The article outlines the severe financial and operational challenges faced by independent physicians due to fee schedule cuts and escalating operational costs. It highlights how the author's gastroenterology practice was affected in 2007, leading to a strategic alliance with other local independent doctors to form a larger group practice. This move underscores the importance of independence and autonomy in patient care, which many physicians value deeply. However, the economic pressures have forced many to sell their practices to larger entities, losing the personal touch and autonomy in patient care.

  2. Founding of the American Independent Medical Practice Association: In response to the diminishing number of independent doctors and the adverse effects this trend has on patient care, the author and other like-minded physicians founded the American Independent Medical Practice Association. This group advocates for independent physicians, emphasizing research findings that independent medical practices often deliver better outcomes at lower costs compared to hospital-owned counterparts. The association's creation is a proactive step towards preserving the traditional model of physician-owned practices amid a rapidly changing healthcare landscape.

  3. Legislative Action and the Future of Independent Medicine: The article calls for legislative action to address the financial disparities and challenges faced by independent physicians, particularly the cuts to Medicare reimbursement rates that fail to keep pace with inflation. It proposes that Congress should work to eliminate or reduce the current year's reimbursement cut and consider indexing Medicare payments to inflation to ensure the sustainability of independent practices. Highlighting the benefits of the traditional practice model, such as personalized care and stronger doctor-patient relationships, the author argues for a healthcare system that prioritizes the interests of patients and doctors over the financial goals of hospitals and insurers.

418 rural hospitals at risk of closure, breakdown by state

By Laura Dyrda - There are about 418 rural hospitals at risk of closure, according to a new report from Chartis, a healthcare advisory services firm. The organization analyzed 16 vulnerability indicators and found nine were statistically significant in predicting hospital closures, including: case mix index, Medicaid expansion, average daily census swing, occupancy, government control status and years of negative operating margin. The hospital's average length of stay and change in net patient revenue also factored into its risk of closure. Read Full Article…

VBA Article Summary

  1. Southeast and Great Plains Regions Face Highest Closure Risks: The Southeast region of the U.S. has the highest percentage of rural hospitals at risk of closure, closely followed by the Great Plains.

  2. States with the Most Vulnerable Hospitals: Texas, Kansas, Nebraska, Oklahoma, North Carolina, Georgia, and Mississippi are the states with the highest numbers of hospitals at risk, with Texas leading at 45 and Mississippi and Georgia both at 18.

  3. Percentage of Rural Hospitals at Risk by State

  • Highest Risk (More than 41%) - Florida, Tennessee, Nebraska

  • High Risk (31% to 40%) - Utah, South Dakota, Kansas, Oklahoma, Alabama, North Carolina, South Carolina

  • Moderate Risk (26% to 30%) - Wyoming, Texas, Louisiana, Arkansas, Mississippi, Georgia

  • Lower Risk (21% to 25%) - Missouri, Illinois

  • Minimal Risk (16% to 20%) - Wisconsin, New York, Massachusetts, Hawaii

  • Lowest Risk (10% to 15%) - California, Idaho, North Dakota, New Mexico, Indiana, Pennsylvania, Virginia

  • Very Low Risk (0% to 9%) - Oregon, Montana, Arizona, Alaska, Colorado, Minnesota, Iowa, Michigan, Ohio, Kentucky, West Virginia, Maryland, Rhode Island, Delaware, Connecticut, New Hampshire, Maine, Vermont, Nevada, Washington, New Jersey

Exclusive: Wegovy fuels sharp rise in use of weight-loss drugs for US youth

By Robin Respaut and Chad Terhune - A small but rapidly growing number of U.S. adolescents began treatment with Novo Nordisk's <NOVOb.CO> weight-loss drug Wegovy last year, a powerful new tool to address record rates of pediatric obesity, according to data shared exclusively with Reuters. Read Full Article…

VBA Article Summary

  1. Significant Increase in Wegovy Prescriptions for Adolescents: In the first 10 months of 2023, there was a dramatic increase in the number of children aged 12 to 17 diagnosed with obesity who began treatment with Wegovy, with 1,268 children starting on the drug, compared to only 25 in 2022. This surge followed its U.S. approval for adolescent use in December 2022 and the subsequent recommendation by the American Academy of Pediatrics to offer weight-loss drugs to children with obesity starting at age 12.

  2. Growing Acceptance and Use Among Families: Despite the high cost and limited data on long-term risks, there is an increasing willingness among families to use Wegovy, reflecting its effectiveness as the first highly effective obesity treatment aside from surgery. This trend is supported by Medicaid data showing at least 464 children in five states were prescribed Wegovy since January 2022, not including those who might have received it through off-label use or without health insurance coverage.

  3. Concerns and Considerations for Youth Obesity Treatment: While the use of Wegovy and similar medications marks a proactive approach to managing pediatric obesity, there are concerns about side effects, long-term impacts, and the need for comprehensive lifestyle changes alongside medication. The story of Billy Small Jr., who saw significant weight loss and quality of life improvement after starting Wegovy, highlights the potential benefits but also underscores the careful consideration families and doctors must give to treating obesity in children and adolescents.

6 Ozempic updates

By Paige Tweeter - Healthcare suppliers and food companies are veering into new business plans amid the booming market for weight loss medications, which is expected to reach $80 billion by 2030. Read Full Article…

VBA Article Summary

  1. Impact on Food Industry: The popularity of GLP-1 medications like Ozempic and Wegovy for weight management is influencing consumer eating habits, leading to concerns among food industry leaders. Companies such as Walmart have observed a reduction in consumer spending on food, prompting food companies like Chipotle Mexican Grill, Nestlé, Conagra Brands, and Danone to adapt by focusing on healthier options to align with changing consumer behaviors.

  2. FDA Warnings and Counterfeit Drugs: The FDA has issued warnings to online companies selling unapproved versions of semaglutide and tirzepatide, highlighting a growing issue with counterfeit GLP-1 drugs. These counterfeit products have been found in medical spas, pharmacies, and clinics. Additionally, Novo Nordisk has taken legal action against companies distributing counterfeit compounded drugs, securing settlements that prohibit the use of their trademarks and claims of FDA approval.

  3. Healthcare and Pharmaceutical Industry Trends: The surging demand for GLP-1 medications is driving growth in the healthcare supply industry, with companies like DHL Supply Chain expanding their manufacturing capabilities. Moreover, new research suggests GLP-1 users may have a lower risk of anxiety or depression, and the prescription rates of these drugs have surpassed those of insulin, indicating a significant shift in diabetes management.

These simple activities can treat depression as effectively as therapy, study says

By Madeline Holcombe - When a wave of depression hits, exercise may sound like the last thing you want to do. But a new study says it could be crucial to feeling better. Many types of exercise — including walking, jogging, yoga, tai chi, aerobic exercises and strength training — showed benefits as strong as therapy when it came to treating depression, according to the study published Wednesday in the BMJ. Read Full Article…

VBA Article Summary

  1. Prevalence and Impact of Depression: Depression affects an estimated 10% to 25% of people worldwide, with significant negative impacts on well-being, surpassing the effects of debt, divorce, or diabetes. Despite its prevalence, only half of those suffering from depression receive any form of treatment. This highlights the critical need for effective treatment options and the importance of addressing the wide-reaching consequences of untreated depression.

  2. Exercise as a Treatment for Depression: A comprehensive analysis of data from 218 studies involving over 14,000 participants suggests that exercise offers significant whole-body benefits that can aid in treating depression. The intensity of exercise appears to be more impactful than the duration or frequency, with even moderate activities like walking showing positive effects. This aligns with previous research, including a 2018 study involving more than 1.2 million Americans, which found that exercise leads to better well-being and mental health, reinforcing the idea that physical activity should be considered a key component of depression treatment alongside therapy and medication.

  3. Challenges and Recommendations for Implementing Exercise: Motivation to exercise can be particularly challenging for individuals with depression, but the study found that setting goals and tracking activity were less effective than anticipated. Instead, seeking support and accountability through joining fitness groups, enlisting a trainer, or partnering with a loved one for walks can enhance motivation. Making exercise enjoyable and part of a structured program that pushes individuals, even slightly, can significantly increase adherence to physical activity. This approach not only addresses the physical aspect of depression but also contributes to overall mental health and resilience.