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Major Insurer Threatens to Leave Obamacare Exchanges


IP Blog | Dave Melin | November 23, 2015

BioBlog Weekly oncologyThis week in healthcare: UnitedHealth may be reconsidering its involvement in the ACA exchange marketplace, which could spell trouble, and ExpressScripts will launch a new pricing model for cancer and anti-inflammation drugs in 2016.

Major Insurer May Exit Obamacare Exchanges

On a recent call with shareholders, UnitedHealth seemed to be reconsidering its ACA exchange plans, saying that they would be “evaluating the viability of the insurance exchange product segment and will determine during the first half of 2016 to what extent it can continue to serve the public exchange markets in 2017.”

New ObamaCare Angst as Top Insurer Threatens to Bail

As UnitedHealth airs its concerns about the viability of participating in the ACA marketplace, others in the industry are feeling the heat as well. According to a spokesperson from America’s Health Insurance Plans, “We’ve been very clear with the Administration about the serious challenges facing consumers and health plans in this exchange market.”

ExpressScripts Aims New Price Model at Cancer, Inflammation

ExpressScripts will introduce a new pricing model for cancer in early 2016, and now it has announced plans to extend this new model to the anti-inflammatory space as well.

Specialty Drugs Now Cost More than the Median Household Income

According to a recent report, “the average annual retail cost of specialty drugs used to treat complex diseases such as cancer, rheumatoid arthritis and multiple sclerosis now exceeds the median U.S. household income.”

World’s Drug Bill to Rise to $1.4 Trillion in 2020, Report Says

Researchers at the IMS Institute for Healthcare Informatics predict that the world’s total annual drug spending will reach a staggering $1.4 trillion by 2020. A large portion of this number will be “dominated” by specialty therapies.

UnitedHealth Group May Invest Deeper into Worker’s Comp PBM Through Helios Buy

Sources in the industry suggest that UnitedHealth Group may be on the version of a $1.6 billion deal to acquire Helios, “a privately owned provider of workers’ compensation and PBM services to large health insurers and third-party administrators (TPAs), handling more than 7 million prescriptions per year.”

Dr. Robert C. Young Joins NCCN Leadership Team

Dr. Robert C. Young has been appointed as the interim Vice President for NCCN’s Oncology Research Program, where he will be “developing and managing NCCN’s centralized, standardized infrastructure for the conduct of clinical trials among its 26 NCCN Member Institutions and their community affiliates.”

Oncologists Become More Vocal about Rising Costs

As drug costs continue to rise, oncologists are becoming increasingly vocal in their criticism of those trends and in their calls for something to be done to address this growing problem.

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