Headwinds for Health Insurers as Obamacare Stumbles

(A version of this Health Alert was published by Forbes). You might think this headline is a gag, given how deeply health insurers are dug into Obamacare. Only a month ago, I wrote that health plans’ mastery of Obamacare poses challenge to repeal. Losses in Obamacare’s controversial exchanges are not yet apparent in the publicly listed insurers’ financial statements. However, exchanges comprise of a small (but not trivial) market of about 11 million people. Through 2016, health plans losing money in Obamacare can rely on taxpayers to help them out. After that, they are on their own. Already, many plans are finding participation painful and increasing Obamacare premiums significantly for 2016. According to Louise Radnofsky of the Wall Street Journal, In New Mexico, market leader Health Care Service Corp. is

Are Insurers Prevailing Over Drug Makers?

Less than a year ago, it looked like health insurers were sending up trial balloons to see if they could get the federal government to regulate the research-based pharmaceutical industry as a utility. This was a reaction to high prices for new drugs like Sovaldi®. Today, the issue is being dialed back: Express Scripts, the largest pharmacy benefits manager in the U.S. initially refused to put Sovaldi® on its formulary. Now, it looks like both sides might have come to a businesslike accommodation: That taught Amgen and other drugmakers a lesson. Avoiding hostility with insurers and PBMs is now a paramount industry goal. “Every company is saying, ‘We don’t want to replicate what happened with Sovaldi. So let’s sit down and talk,’ ” says