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Molina Healthcare reported a third-quarter revenue increase of 18% year-over-year, surpassing financial expectations, with adjusted net income rising 19% to $6.01 per diluted share. Despite higher medical costs and a retroactive premium rate reduction in California, the company remains optimistic about future rate adjustments and growth initiatives in Florida and Michigan. Shares of Molina surged 23%, reflecting positive market sentiment, while peers like Centene and Elevance Health also saw gains.
The American Medical Association (AMA) and the Illinois State Medical Society have filed an antitrust lawsuit against MultiPlan, alleging the company engages in price-fixing with major insurers, harming competition and forcing physicians to accept low reimbursement rates. The lawsuit claims MultiPlan's revenues from repricing out-of-network payments surged from $23 million in 2012 to $709 million in 2021, while also facilitating confidential information sharing among insurers to suppress rates. Major insurers like UnitedHealth Group, Aetna, and Cigna are named as co-conspirators in the case.
Medicare Advantage plans received $7.5 billion in risk-adjusted payments, raising concerns over potential upcoding by major insurers like UnitedHealth Group and Humana. A federal report revealed that $4.2 billion stemmed from at-home visits, which accounted for only 13% of chart reviews in 2022, with many diagnoses lacking follow-up care. The report urged stricter oversight from CMS, highlighting that 75% of payments were linked to just 13 conditions, primarily identified through at-home assessments.
Executives from various healthcare sectors, including Blue Shield of California, are calling for an end to the pharmacy benefit manager (PBM) model, citing misaligned incentives that inflate drug costs. They advocate for transparent fee structures and direct deals with drug manufacturers to reduce expenses. The Federal Trade Commission has criticized PBMs for anticompetitive practices, urging a realignment of incentives to benefit patients rather than middlemen.
Cigna and Humana are reportedly nearing a significant merger that could reshape the healthcare industry. This potential deal raises important questions regarding the implications of consolidation within the health insurance and pharmacy benefit manager sectors.
Cigna has revived merger discussions with Humana, although they remain in the early stages and no agreement has been reached. Cigna plans to finalize the sale of its Medicare Advantage business before pursuing further deals. The Federal Trade Commission is closely monitoring healthcare mergers, having recently increased pre-merger notification requirements.
The 2025 Medicare Advantage star ratings reveal a decline for major insurers like UnitedHealth and Humana, with Humana experiencing the largest drop at 0.74 stars. In contrast, insurtechs like Clover Health and Alignment Healthcare saw significant improvements, with Clover achieving a 4-star rating for its PPO offering. As open enrollment approaches, Humana is contesting its scores, while UnitedHealth is pursuing legal action over a call center issue.
UnitedHealth Group and CVS Health are seeking the recusal of FTC Chair Lina Khan and two commissioners from a lawsuit against major pharmacy benefit managers (PBMs) over alleged anticompetitive practices that inflate insulin prices. They argue that the commissioners have shown bias against PBMs, claiming their public statements indicate a prejudgment of the case. The FTC's lawsuit, filed in September, targets CVS Caremark, Express Scripts, and Optum Rx for creating a rebate system that has contributed to soaring insulin costs.
UnitedHealth Group, CVS Health, and Cigna have filed motions to remove FTC Chair Lina Khan from an antitrust lawsuit regarding insulin pricing, claiming bias due to her public statements and appearances. They also seek the recusal of two other commissioners involved in the case. The lawsuit alleges that these pharmacy benefit managers engaged in unfair rebate practices that inflated insulin prices, while Khan's supporters defend her aggressive antitrust stance amid calls for her replacement from some wealthy donors.
Cigna Corporation
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