Latest news with #MassachusettsAssociationofHealthPlans
Boston Globe
28-02-2025
- Health
- Boston Globe
Fast-rising costs for weight loss drugs helped drive record loss for Blue Cross Blue Shield of Massachusetts
Blue Cross chief financial officer Ruby Kam said the entire health insurance sector nationally is grappling with escalating medical costs, including from GLP-1 drugs. But while most national insurers reimburse for those drugs only when they're used to treat diabetes, Blue Cross and other Massachusetts insurers also cover their use to treat obesity. The costs, which are projected to double again in 2025, will likely boost premiums for Blue Cross members even as the insurer works to hold down claims increases from hospitals and its own administrative costs, which make up about 10 percent of its revenue, Kam said. Advertisement 'Our premiums are not covering our expenses,' Kam said in an interview. 'We're looking at how to address this. Everything's on the table.' Among other things, Kam said Blue Cross executives are weighing whether they can continue reimbursements for GLP-1 therapies prescribed to treat obesity. No decision has yet been made. Massachusetts saw the country's third-highest increase in GLP-1 prescriptions for obese patients in 2024 compared to the prior year, driven in part by broad insurance coverage for the drugs here, the Other health insurers in Massachusetts are also feeling the squeeze. Most of the state's health plans have been losing money for the past several quarters, said Lora Pellegrini, president of the Massachusetts Association of Health Plans, a trade group for the insurers. Advertisement 'We know from over two dozen state reports that provider prices and pharmaceutical prices are the key drivers of health care costs,' Pellegrini said. 'We have to have a serious conversation in the state about the prices being charged by the pharmaceutical industry.' Blue Cross reported an overall net loss of $223.6 million last year on revenue of $9.7 billion, a 2.3 percent net loss margin. Its operating loss of $400.4 million, a 4.3 percent loss margin, was partly offset by investment income of $176.8 million. A year earlier, the insurer posted net income of $146.6 million, a 1.6 percent net loss margin. In a message posted on the Blue Cross website Friday, chief executive Sarah Iselin, said the health care system faces multiple stresses from a shortage of primary care and mental health providers to rising costs from breakthrough medicines and medical procedures, creating affordability challenges for consumers and employers. 'Given the current environment, we don't expect the cost pressures to ease off any time soon,' Iselin wrote. 'So, in the coming year and beyond, we'll be taking an even more disciplined approach to become more efficient in the running of our business, while continuing to work aggressively and collaboratively to slow the growth in spending for medical and pharmacy services.' Robert Weisman can be reached at
Yahoo
08-02-2025
- Health
- Yahoo
Push continues for brain injury treatment coverage
BOSTON (SHNS) – After their brain injury treatment legislation cleared one committee but then fizzled out last session, Sen. Paul Feeney and Rep. Kimberly Ferguson urged survivors Tuesday to share personal stories with lawmakers to help get the policy over the finish line in the new session. The advocacy push came as the leader of the Massachusetts Association of Health Plans (MAHP) voiced her opposition to the insurance mandate, which she said would raise costs for consumers and small businesses. The proposed benefit also leaves a major coverage gap for Bay Staters on certain insurance plans, CEO Lora Pellegrini pointed out. At a Brain Injury Association of Massachusetts (BIA-MA) event, Feeney recalled the good news he shared with advocates last year: The bills he sponsored with Ferguson requiring commercial insurers to cover cognitive rehabilitation therapy to treat brain injuries received a favorable report from the Financial Services Committee, which the Foxborough Democrat co-chaired. While the Health Care Financing Committee later sent the bills to study, Feeney and Ferguson said they're optimistic about the fate of their refiled proposals (SD 1890 / HD 866). Massachusetts may be a leader in health care, but 'if it's not affordable, it's not accessible,' Feeney said. 'I want to urge you to have the optimism that I have, that as we start here today at the beginning of the session, we will not only get that bill out again and move it forward, but we will get it over the finish line this year. And I don't say that lightly,' Feeney told advocates before they headed to meetings with lawmakers. He added, 'I promise you all that nothing motivates us and moves policy like your personal stories, like the stories of courage and persistence, the stories that turn pain into purpose.' Insurance coverage would extend to people with an acquired brain injury (ABI), such as a traumatic brain injury, tumor, stroke and aneurysm. Pellegrini warned the proposals would add to seven new coverage mandates from last session, which she said will raise premium costs by $750 million over the next five years. 'In Massachusetts, those costs are borne primarily by small businesses and individuals who make up less than 40% of the employer-sponsored market,' Pellegrini said. 'Self-insured plans, which comprise over 60% of the commercial market, are not required to add this mandate or others as part of a benefits package. ' Lawmakers and supporters emphasized their advocacy builds on a narrower success story from a 2021 health care law, which required commercial health insurance plans, the Group Insurance Commission and MassHealth to cover cognitive rehabilitation for COVID-19 patients. More than 72,000 Bay Staters each year sustain a traumatic brain injury, which can cause impaired thinking, memory, movement, sensation and emotional functioning, according to BIA-MA. Only 12% of affected individuals receive inpatient rehab, and the legislation would help more Bay Staters access treatment with the aim of living more independently, the association says. A former speech language pathologist, Ferguson said cognitive rehab therapy allows patients to retrain their brains, including by working on word retrieval and comprehension. Aside from questions about how much the policy would cost, Ferguson said she's heard 'very, very little opposition.' A 2016 analysis from the Center for Health Insurance and Analysis found the coverage mandate would raise monthly insurance premiums between 1 cent and 19 cents. 'It's several years old, so we've been told maybe we need to go back to CHIA again and say, can you update those numbers for us? But I mean, no one really has an argument against helping ABI survivors improve their skills and become more functional in their day-to-day lives,' Ferguson said. 'I've said it year after year: This is one of the most important bills that we can pass to change lives for people with ABI, their families and their caregivers.' Demanding that lawmakers not raise costs for small business, Pellegrini said the Legislature should impose a 'moratorium on new health care spending.' 'Without such action, continued coverage expansions and cost-sharing eliminations will only contribute to our affordability crisis,' Pellegrini said. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
