Humana stock slides on lower ratings for its Medicare Advantage plans

By Anjalee Khemlani - Humana (HUM) saw its stock dive Wednesday morning after announcing Medicare's star ratings resulted in lower enrollment for 2025 and will impact revenue in 2026. The changes will also impact the company's bonuses for 2026. Read Full Article… 

HVBA Article Summary

1. Stock Impact and CMS Rating Reduction: Humana's stock is down by 15% to $235.75 per share after a significant decline of over 20% in premarket trading. This drop follows the Centers for Medicare and Medicaid Services (CMS) lowering the rating of Humana's Medicare Advantage plans from 4.5 to 3.5 stars for 2024, which has affected both its stock performance and its reputation as a top-rated plan provider.

2. Rising Medical Loss Ratios and Impact on Profitability: Humana, along with CVS, has been facing higher-than-expected medical loss ratios (MLR) due to increased utilization by seniors. Humana reported an increase in its MLR to 89% for the first half of 2024, up from 86% in 2023, while CVS reported a jump to 90% from 85%. These rising costs, along with pressures from CMS, are expected to lead to cuts in benefits and potentially fewer plans for 2025.

3. CMS Ratings Influence and Upcoming Announcement: CMS star ratings play a crucial role in determining reimbursement levels and influencing consumer choices. Humana is currently awaiting the final official ratings, expected to be released by CMS on October 10. The company is also appealing some of CMS's decisions, and this marks the second instance this year where stock value has been impacted by negative news regarding its Medicare Advantage plans.

The midlife health care cost crisis of insured employees

By Kristen Beckman - Having employer-sponsored health insurance does not insulate midlife adults – those between the ages of 50 and 64 – from the burden of high health care costs. This cohort faces higher rates of chronic conditions and requires additional routine care as they age, but high costs drive many people to delay or avoid medical care because they can't afford it, according to an AARP report. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Premiums and Out-of-Pocket Costs for Midlife Adults: Since 2011, premiums for midlife adults (aged 50+) with single coverage plans have increased by 38%, compared to just 25% for younger adults, according to a study by AARP and NORC. Additionally, nearly half of these individuals have health insurance deductibles exceeding $1,400 annually, with one-fifth spending over 10% of their income on healthcare costs.

2. Financial Strain Leading to Reduced Medical Care: A significant number of midlife adults are facing financial difficulties due to rising healthcare costs, with one-third reporting problems paying for care. Many are forced to delay or forgo essential care, including dental, vision, and primary care services, as they balance medical expenses with other necessities like food and utilities.

3. AARP's Policy Recommendations to Reduce Costs: To address the growing healthcare burden on midlife adults, AARP advocates for reforms that include promoting transparency, preventing anti-competitive behavior in healthcare markets, improving coverage and access to preventive care, and leveraging technology to improve efficiency and reduce costs.

End of obesity drug shortage threatens patient access to compounded shots that Lilly calls risky

By Shelby Livingston - Telehealth companies and patients are grappling with the potential loss of access to cheaper, alternative versions of Eli Lilly’s popular GLP-1 weight loss drug tirzepatide after the FDA said its shortage has been resolved. Read Full Article… 

HVBA Article Summary

1. Compounded Versions in High Demand: During shortages of brand-name tirzepatide and semaglutide, many telehealth sites, med spas, and clinics have taken advantage of the opportunity to prescribe compounded versions of the drugs, which are not FDA-approved but are more affordable. Patients with limited coverage for weight loss treatments have turned to these alternatives in large numbers.

2. Lawsuits and Regulatory Scrutiny: Eli Lilly has aggressively pursued legal action against compounders, warning that mass-production of tirzepatide compounds must stop due to risks such as high impurity levels. Meanwhile, compounded versions continue to be sold, with some telehealth providers anticipating they can still supply the drugs for a limited time.

3. Patient Uncertainty Amid Supply Changes: Patients using compounded tirzepatide face difficult choices as supply lines tighten. Some may switch to more expensive, FDA-approved versions, try cheaper but less effective obesity drugs, or stop treatment altogether. Telehealth providers like Fifty 410 and Lavender Sky Health are navigating these challenges while looking for alternative solutions to maintain access.

U.S. Healthcare System Ranks Last Among 10 Nations, According To New Study

By Joshua P. Cohen - Among ten peer nations, Americans live the shortest lives and are the least healthy, despite the United States spending the most on healthcare, according to a recent Commonwealth Fund study. Read Full Article…

HVBA Article Summary

1. High Spending, Poor Outcomes: The U.S. spends more on healthcare per capita than any other industrialized nation, yet it ranks last in life expectancy and health outcomes among comparable countries. Despite significant investment, the U.S. sees worse performance on key metrics like preventable deaths, access to care, and health equity.

2. Barriers to Affordable Healthcare: The lack of universal health coverage in the U.S. contributes to significant barriers for millions of Americans in accessing affordable healthcare. With 25 million uninsured and over 100 million carrying medical debt, even those with employment and insurance face high costs and limited care options.

3. Complexity and Fragmentation: The U.S. healthcare system’s complexity, due to its mix of private and public insurance, imposes significant administrative burdens on both patients and providers. This fragmentation leads to inefficiencies, making it harder for individuals to access regular care and for providers to navigate insurance and billing systems.

DOL Echoes Employee Benefits and Cybersecurity Best Practices

By Amanda Dernovshek, Taylor A. Gast, and Mindi Johnson - On April 14, 2021, the U.S. Department of Labor’s (“DOL”) Employee Benefits Security Administration (“EBSA”) issued its first cybersecurity best practices guidance for retirement plans. The EBSA guidance was highly anticipated as the frequency and cost of data breaches affecting employee benefit plans continues to rise. Read Full Article…

HVBA Article Summary

1. Hiring Third-Party Service Providers: Plan sponsors should conduct thorough due diligence when hiring service providers, ensuring they have strong cybersecurity practices in place. This includes inquiring about past security breaches, assessing the provider's insurance coverage for cybersecurity incidents, and including ongoing cybersecurity compliance clauses in contracts.

2. Cybersecurity Program Best Practices: The EBSA recommends adopting a formal, well-documented cybersecurity program that includes annual risk assessments, third-party audits, clearly defined roles, and regular cybersecurity awareness training to protect benefit plan infrastructure and data.

3. Participant Online Security Tips: Participants are encouraged to follow online security tips, such as using multi-factor authentication, monitoring their accounts regularly, and avoiding accessing accounts on unsecured networks like free Wi-Fi. Plan sponsors should promote these tips to their participants to safeguard retirement accounts.

The debate over obesity treatment: Drugs vs. lifestyle changes

By Allison Bell - The head of a company that helps brokers and employers manage obesity risk warned recently against assuming that Ozempic, Wegovy and their competitors will win the weight-control war. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Individualized Treatment Approach: Elina Onitskansky emphasizes that obesity treatment should not be treated as a one-size-fits-all solution. While GLP-1 agonists may be effective for some, others may benefit from behavioral therapy or bariatric surgery. She stresses the need for personalized care that moves beyond rigid diet culture.

2. Range of Treatment Options: Ilant Health provides a comprehensive range of obesity care options, including behavioral therapy, anti-obesity medications, and bariatric surgery, each offering varying levels of weight loss potential. Onitskansky highlights the importance of helping individuals find the right combination of medical and lifestyle interventions.

3. Emotional and Mental Health Support: Onitskansky advocates for the integration of emotional and psychological support in obesity care. Recognizing that obesity affects self-perception and mental health, Ilant ensures that counseling is part of its services to address the emotional challenges associated with weight management.

CDC warns of potential overdose risk from online pharmacy prescriptions

By Andrew Rhoades - The CDC issued a warning to health care officials, clinicians and patients about a potential risk for overdose among people ordering counterfeit prescription medications from online pharmacies. Read Full Article…

HVBA Article Summary

1. DOJ Charges in Illegal Pharmacy Operation: The DOJ charged 18 defendants involved in running illegal online pharmacies that distributed unregulated drugs, including fentanyl and methamphetamine, leading to multiple deaths and the seizure of nine website domains.

2. Rise in Unregulated Prescriptions: The number of prescriptions dispensed by illegal online pharmacies increased from 64 million in 2019 to 85 million in 2022, with 12.6% of related adverse events potentially avoidable through legal pharmacy channels.

3. CDC Consumer Warnings: The CDC warns consumers to avoid unlicensed online pharmacies, advising that people should only take medications prescribed by licensed healthcare providers and obtained from licensed pharmacies to avoid counterfeit and dangerous drugs.