New York City has ended coverage for GLP-1 weight-loss drugs, citing an error in their inclusion, while continuing to cover them for diabetes. Meanwhile, Michigan has filed a lawsuit against PBMs Optum Rx and Express Scripts for alleged collusion with opioid manufacturers, seeking accountability for their role in the opioid crisis. Additionally, health plans are previewing their Medicare Advantage offerings for 2025, with various expansions and new benefits aimed at diverse populations.
Employers are increasingly worried that rising healthcare costs will force them to make difficult trade-offs with wages and salaries, according to a recent survey. About 74% of the 188 employers polled believe these costs will lead to shifting more expenses onto workers, with prescription drug prices, high-cost claims, and hospital prices identified as the top concerns. Many are considering changes to their pharmacy benefit managers and exploring strategies to manage high-cost claims, reflecting a broader struggle for sustainability in the face of escalating healthcare expenses.
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.
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