Closer Look
Fed up with flagrantly high prices, employers and workers take health insurers to court
Push has come to shove for companies, unions, and workers frustrated by exorbitant prices for health coverage. They're suing health insurers based on the belief that hospitals, doctors, and other providers are charging flagrantly high prices without fear of pushback because they ultimately get paid. And employers allege that insurers use contracts to block claims data so effectively that it's impossible to know what they're being charged. Three examples:
- A woman alleged her employer's insurer, CVS Health's Aetna, conspired with a subcontractor, UnitedHealth's Optum, to create "dummy codes" for certain services.
- Ford sued Blue Cross Blue Shield of Michigan, and the broader network of Blues plans, alleging the Blues "divided territory and fixed prices" like a cartel.
- Unions representing laborers in Connecticut sued Elevance Health and alleged it blocked the unions from obtaining their own claims data and overcharged them by willingly overpaying providers.
STAT's Bob Herman has more, including insurers' responses.
biotech
FDA advisers endorse new Alzheimer's drug. Next up: payment questions and competition
A unanimous vote by an FDA panel of experts clears the way for expanded approval of Leqembi, an Alzheimer's treatment from Eisai and Biogen that won provisional FDA approval in January. The agency isn't required to abide by the expert's 6-0 vote in its final decision, expected by July 6, but FDA staff repeatedly endorsed Leqembi's supporting data Friday. What's less clear is what might happen with payment for the drug, given by infusion every two weeks and estimated to cost $26,500 a year.
Medicare currently all but forbids reimbursing for new Alzheimer's drugs, but has promised to loosen those restrictions if Leqembi wins full FDA approval — although details of future coverage remain unclear. More certain is the competition Leqembi will likely face in 2024, when Eli Lilly seeks FDA approval for donanemab, its amyloid-targeting therapy that slowed patients' rate of decline. STAT's Adam Feuerstein and Damian Garde have more.
health tech
Opinion: Why they created a chatbot to address eating disorders
Adobe
Once people develop eating disorders, fewer than 20% ever receive any care. Because Ellen Fitzsimmons-Craft of Washington University and C. Barr Taylor of Stanford have committed their careers to increasing detection of and care for eating disorders, they agreed to develop a chatbot called Tessa to help. Neither has a commercial interest in Tessa, they note in a STAT First Opinion.
After an NPR story on the chatbot aired in May, the backlash began. Bringing in health tech rather than human touch for eating disorders is wrong, critics said. More blowback came after, unbeknownst to the authors, the company that hosts Tessa rolled out an AI component, one that encouraged dieting, the Wall Street Journal reported. "We could not have been more disappointed and upset to hear this," Fitzsimmons-Craft and Taylor write. Read more on how they still believe a chatbot — not ChatGPT — might help meet the need for trained therapists.
Alex Hogan/STAT
No comments