Latest news with #MatthewVeno
Boston Globe
21-05-2025
- Health
- Boston Globe
State health plan shortfall points to challenge of expensive weight loss drugs
Get The Gavel A weekly SCOTUS explainer newsletter by columnist Kimberly Atkins Stohr. Enter Email Sign Up Injectable GLP-1 drugs were initially developed to treat diabetes, then approved for obesity. Their popularity has risen among consumers eager to lose weight, and the drugs carry enormous potential health benefits in mitigating the risks of obesity-related disease. But they are expensive, with annual list prices as high as $16,000 and net prices, after discounts, of $7,000 to $9,000, according to Advertisement Increased use of GLP-1 drugs was not the only factor in GIC's shortfall, but these medications have been causing GIC's costs to rise for years. Advertisement According to In the long term, drug prices may come down as more drugs enter the market and competition increases. Medicare will negotiate prices for some of these drugs to take effect in 2027. US consumers already pay more than Europeans for the same medication, and the ultimate solution will need to involve finding some way to lower prices for American consumers. In the short-term, GIC is right to consider what solutions best balance cost and access. The main change announced so far is that beginning in July, CVS Caremark will 'prefer' the GLP-1 drug Wegovy. That means patients will no longer receive insurance coverage for another GLP-1 drug, Zepbound, unless they obtain an exception and pay a higher copay. The decision encouraged competition that enabled CVS Caremark to negotiate a lower price. CVS Caremark says its clients, including GIC, are expected to save 10 percent to 15 percent on their anti-obesity medicine costs. It's a strategy similar to one used by MassHealth. In January, Advertisement More changes for state employees' coverage may be forthcoming. GIC executive director Matthew Veno said at Thursday's meeting that GIC continues to be 'actively evaluating steps that we can take to strike the right balance between cost and access.' At a prior Some other public plans are going further. North Carolina's state employee health plan last year On the commercial market, Blue Cross Blue Shield Massachusetts There is a benefit to giving employers choice in how much they want to pay for what coverage. The downside is when employees aren't covered, it creates inequality where only the wealthy can get drugs. Drugmakers now offer products directly to cash-paying consumers, with a year's supply of Advertisement Compounded versions of the drugs also became available when these drugs were deemed to be in shortage in 2023 and 2024, and Another important way to contain costs is to make sure patients who seek insurance coverage for GLP-1 drugs actually need them. But there isn't consensus on how to do this. Some insurers require step therapy, first forcing patients to try a different drug or engage in a lifestyle management program. MassHealth requires members to try an oral appetite suppressant. But step therapy can potentially harm a patient — and make treatment longer and more expensive — if an insurer first requires a treatment not recommended by the patient's physician. There is a need for clinical guidelines to determine when someone qualifies as obese. But the main clinical measure used is body mass index, which Connecticut's state health insurance plan is experimenting with outsourcing obesity treatment to a third-party organization, FlyteHealth, which employs experts who prescribe GLP-1 and other drugs and use lifestyle management approaches. That model deserves more study to determine impacts on cost, care quality, and health outcomes. There's no easy answer, but Massachusetts state officials deserve credit for trying to find ways to maintain coverage while cutting costs. Advertisement Editorials represent the views of the Boston Globe Editorial Board. Follow us
Yahoo
15-05-2025
- Health
- Yahoo
With hospitals at risk, Mass. eyes lifeline for broke insurer covering 460K public employees
Editor's note: Story was updated Thursday afternoon to include a statement from GIC. Amid fears of 'serious financial consequences,' Massachusetts is working to create a lifeline for a Massachusetts agency that oversees health insurance for 460,000 public employees, retirees and their dependents after it could not continue to pay providers. In January, state Group Insurance Commission (GIC) Executive Director Matthew Veno had flagged the agency's budget shortfalls as a concern. 'This is the largest variance that we've seen in at least a decade, and this is consistent across all of our plans, and is driven primarily by rising provider prices and a couple of other topics,' he said at the time. 'We don't know where this is going to head. My concern is that it is a persistent and steady trend going forward.' Then in April, Veno said rising provider prices and increased utilization of prescription benefits, including for GLP-1 weight loss drugs, had caused the commission to run an average $20 million monthly deficit this fiscal year. Massachusetts Health & Hospital Association (MHA) said it was 'unacceptable' for the insurance agency to have a lack of backup options and claims the disruption in payments 'will undoubtedly result in serious financial consequences.' Read more: Mass. health insurance companies directed to limit growth of deductibles, copays Mercy Medical Center in Springfield said it 'is not in a financial position to absorb budget shortfalls of the state Massachusetts Group Insurance Commission.' 'While we appreciate the financial situation of the GIC, we join them in advocating for funding to resolve its budget deficiency that will not further exacerbate the financial condition of healthcare providers,' the statement continued. But the Massachusetts Legislature didn't act before GIC officially ran out of money on Monday. All claims have remained pending since then. The commission had been counting on a $237 million appropriation request before the Legislature. The appropriation was the largest single request in a $756 million short-term spending bill Gov. Maura Healey filed in early April. However, in an email sent to providers earlier this month, the GIC warned that it 'does not know how soon the legislature will pass the bill and when the GIC will receive the requested funds.' The claims will remain pending until GIC receives the additional funds or until July 1. This week, Massachusetts began moving forward on the requested funds. The House advanced a $240 supplemental budget for the agency on Monday. And the Senate passed it on Thursday. 'Ensuring that the hundreds of thousands of public employees and their loved ones have access to health insurance is one of our most important responsibilities,' said Senate President Karen E. Spilka, D-Middlesex/Norfolk. Now it is set for Healey's desk. 'The GIC is grateful to the House and Senate for passing the Governor's supplemental budget request. We look forward to lifting the hold on claims payments and promptly resuming payment of pended claims following the Governor's signature of the legislation,' GIC said in a statement to MassLive. 'We appreciate the patience of plans and providers as we worked toward resolution in a way that would minimally impact our members.' But this isn't unique to GIC. 'The Group Insurance Commission is facing a challenge that is not unique to any insurer, as pharmaceutical usage is going up and the costs of drugs are rising at an unsustainable rate,' said Senator Cindy F. Friedman, D-4th Middlesex, the Senate's chair of the Legislature's Joint Committee on Health Care Financing. 'The Senate is actively working on measures to address this larger issue, as well as other cost drivers throughout the health care system, to relieve the pressure on insurers and the premiums that residents in the Commonwealth face,' the Arlington lawmaker continued. 'As we work towards the end goal of stabilizing health care costs, this supplemental funding for the GIC will ensure that our state employees stay covered and healthy.' Mass. health insurance companies directed to limit growth of deductibles, copays 'Unacceptable': Health insurer for 460K Mass. public workers goes broke without backup plan Insurance program for 460,000 Mass. residents runs out of money Monday Read the original article on MassLive.
Yahoo
13-05-2025
- Health
- Yahoo
‘Unacceptable': Health insurer for 460K Mass. public workers goes broke without backup plan
A Massachusetts agency that oversees health insurance for 460,000 public employees, retirees and their dependents is unable to pay providers after running out of money. But a Massachusetts group is calling it 'unacceptable' for the insurance agency to have a lack of backup options. In January, The Group Insurance Commission (GIC) Executive Director Matthew Veno had flagged the agency's budget shortfalls as a concern. 'This is the largest variance that we've seen in at least a decade, and this is consistent across all of our plans, and is driven primarily by rising provider prices and a couple of other topics,' he said at the time. He added, 'We don't know where this is going to head. My concern is that it is a persistent and steady trend going forward.' In April, Veno said rising provider prices and increased utilization of prescription benefits, including for GLP-1 weight loss drugs, had caused the commission to run an average $20 million monthly deficit this fiscal year. With the fiscal year set to end June 30, the commission is counting on taxpayers to cover its deficit and has a $237 million appropriation request pending before the Legislature. The appropriation was the largest single request in a $756 million spending bill Gov. Maura Healey filed in early April. However, in an email sent to providers on Friday, the GIC warned that it 'does not know how soon the legislature will pass the bill and when the GIC will receive the requested funds.' Instead, starting Monday, payment to providers for GIC member claims have been pending. They will remain pending until GIC receives the additional funds or until July 1. The payment delay does not affect any other government programs, such as MassHealth or Medicare, according to the email. The Massachusetts Health & Hospital Association (MHA) claims the disruption in payments 'will undoubtedly result in serious financial consequences.' Other than the bill, the association points out the GIC did not have any other contingency plan to handle the problem despite saying the funding shortfall was a 'concern' since the beginning of the year. Not looking at other options, MHA's Executive Vice President and General Counsel Mike Sroczynski said is 'unacceptable.' 'Massachusetts hospitals and health systems are not in a financial position to assume the budget shortfalls of the GIC program. While we appreciate the financial situation of the GIC, this directive is an unacceptable contingency plan to those challenges. We implore the GIC to seek an immediate, alternative resolution to its budget deficiency that will not further exacerbate the financial condition of healthcare providers,' Sroczynski wrote. Veno said he isn't worried about 2026's budget. In April, commission members asked about whether the GIC might need to adjust its fiscal 2026 budget request to reflect the higher fiscal 2025 costs. Veno said no adjustment is necessary. 'While we have been consistently running a deficiency, it's been pretty consistent. So we were able to build an FY '26 budget that reflects those trends,' he said. State House News Service contributed to this reporting. These surprising names topped the US fastest-growing baby names of 2024 Man dies in fire at his Marlborough home, no working smoke alarms found Lowell man sentenced for trafficking over 11K fake Adderall pills containing meth These are the most popular baby names of 2024: See the list Waymo plans to map Boston area streets using its self-driving vehicles Read the original article on MassLive.
Yahoo
12-03-2025
- Health
- Yahoo
Health care cost surge adds to Mass. affordability woes
BOSTON (SHNS) – Health care costs in Massachusetts surged at 'unsustainable' levels in 2023, adding more pressure to already-strained household budgets, according to new state data. Total health care expenditures per capita grew to $11,153 from 2022 to 2023, an 8.6% leap that was the second-largest increase since officials began tracking the annual change a decade earlier, the Center for Health Information and Analysis reported Wednesday. The 2023 rate was more than double the 3.6% 'benchmark' that policymakers set as the goal for keeping health care cost growth within a reasonable range. That benchmark is up for debate at a hearing on Thursday. 'For 2023, we are seeing unsustainable cost growth trends persist, putting increasing pressure on residents, employers, and the system as a whole, emphasizing the urgent need for bold and systemic solutions,' said CHIA Executive Director Lauren Peters. The growth rate in 2023 trailed only the 9% increase from 2020 to 2021, when health care spending rebounded after plummeting during the first year of the COVID-19 pandemic. From 2021 to 2022, total health care spending per capita grew 5.8%. At the time, that was the second-highest rate behind the pandemic-impacted outlier. The sharp change will increase pressure on Beacon Hill to rein in health care costs, especially as affordability more broadly — from housing prices to energy bills — remains a central concern. During a series of hearings about health care costs earlier this year, before CHIA published its 2023 data, officials warned about pocketbook impacts from rising health insurance costs. Matthew Veno, executive director of Group Insurance Commission, which oversees insurance for 460,000 state employees and retirees, said the GIC has seen 'pretty significant increases' in premiums in recent years. 'So when we are facing rising pressures on affordability, rising underlying costs of health care, that has a significant burden on the state budget,' he said. 'And whenever we talk about health care, we should always talk in terms of tradeoffs. The dollars that we spend to provide essentially the same benefit going forward inhibits our ability to make progress in other areas, most notably health equity, behavioral health, but also to relieve the pressure as much as we can on our members who pay a significant portion of their premium, but also on the state budget.' CHIA said pharmacy spending and new MassHealth supplemental payments to hospitals drove growth in 2023. Net of rebates, pharmacy spending increased $1 billion or 10% year over year, and MassHealth administered about $1.5 billion in new payments to hospitals designed to support quality and health equity efforts, the report said. But the effects spilled down to individual patients, too. Between 2021 and 2023, premiums grew 12.1% and health insurance member cost-sharing grew 12.9%, both higher than the 9.7% statewide increase in wages and salaries over the same span, according to CHIA. A bit more than two in five Massachusetts residents reported facing a health care affordability issue in the past 12 months, and the rate was even higher among certain demographic groups such as Hispanic residents (58.2%) and non-Hispanic Black residents (48.7%), CHIA said. Hospital finances improved somewhat from fiscal year 2022 to fiscal year 2023, the latest full budget cycle covered by CHIA's new report, while remaining tight. Across the state, the median acute hospital operating margin grew from -1.3% in hospital fiscal 2022 to 0.2% in hospital fiscal 2023. Just more than half of acute care hospitals reported positive operating margins in HFY 2023, CHIA said. State analysts, watchdogs and lawmakers will discuss the new CHIA data at a hearing Thursday, where the Health Policy Commission and the Legislature's Health Care Financing Committee will consider adjusting the cost growth benchmark moving forward. In January, Veno said the GIC was 'experiencing significant budget shortfalls' midway through fiscal 2025, and was more than $100 million over budget. 'This is the largest variance that we've seen in at least a decade, and this is consistent across all of our plans, and is driven primarily by rising provider prices and a couple of other topics,' he said. He added, 'We don't know where this is going to head. My concern is that it is a persistent and steady trend going forward.' Under questioning from Insurance Commissioner Michael Caljouw, Veno later added, 'We're looking at a 10 and a half percent increase for fiscal '26.' Veno identified medical innovation, increased inpatient care utilization and drug prices, including a surge in weight loss drugs, as among the factors driving up prices. He cited a 'steady trend' of 10% increases in pharmacy benefit costs, and projected a 14% increase in the 'active spend' on pharmacy benefits at the GIC for fiscal 2026, which begins July 1. Health care providers are demanding higher prices in negotiations with insurers, Veno said. He gave the example of a provider demanding a 50% increase in rates over three years. 'It was a hard first position,' he said. 'It was not simply expanding the field of negotiation. And what we've also seen is a willingness on the providers to terminate contracts if they don't get the rate increases that they're seeking.' 'I would say, over the last year, it's been relatively non-stop that these rate negotiations have gotten extremely contentious,' Veno added. 'We frequently see and hear about double digit increased demands from providers and a very aggressive posture.' Caljouw, who has been hosting the health care cost sessions, said Massachusetts was at a 'uniquely challenging moment.' 'It's certainly a national issue in terms of scope, but the regional impacts and the impacts directly on individual purchasers, whether they're businesses or individuals, is real and felt,' Caljouw said in January. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
