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Bias and stigma are to blame for the way women’s health research has fallen behind, according to Monica Christmas, M.D., director of UChicago Medicine’s menopause program and the Center for Women's Integrated Health and Valentina Sartori, Ph.D., the leader of the McKinsey Health Institute's Life Sciences Practice in Europe. 

The Global Impact of Underfunding Women’s Health 

Funding will be cut to $10 million, which is a nearly 90% decrease from 2024’s budget of $98 million. 

CMS Announces Cuts to ACA Navigator Program  

Lenacapavir is a twice-yearly injectable medication designed to be used as pre-exposure prophylaxis (PrEP). The FDA is giving this drug a priority review and expects to make a decision by June 19, 2025, according to a release.

FDA Accepts NDA for Gilead's New HIV Prevention Shot

Aaron J. Kowalski, Ph.D., CEO of Breakthrough T1D, spoke with Managed Healthcare Executive, about the possible impacts of the NIH’s cuts to indirect research funding.

Cuts to Indirect Research Costs To Impact Type 1 Diabetes

Managed Healthcare Executive provides C-suite executives at health plans and provider organizations with news, analysis, insights, and strategies to pursue value-driven solutions.

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Marge Ciancetta is the product manager of Cotiviti’s Star Intelligence solution.

With the introduction of the Health Equity Index (HEI) to Star Ratings methodology, health plans have yet another incentive to address health disparities.


Health Equity: Why It’s Vital to Star Ratings Performance

Although doctors prescribe pharmaceuticals for various ailments, they also understand that drugs are only one way to improve a patient’s health. Another is food. The “food is medicine” movement is not new, but it is gaining prominence. The idea is to bolster treatment by providing nutritious foods and medically tailored meals to address diet-related illnesses (diabetes, heart disease and some cancers) and supporting those with conditions such as cancer and kidney disease.

The food is medicine concept is wide-ranging, from specifically made, medically tailored meals to produce prescriptions to nutrition security programs such as the Supplemental Nutrition Assistance Program. One problem for payers — whether government programs, private insurers or philanthropies — is ensuring that the program provides nutritious and appropriate foods. What’s missing from this equation is standards.

Studies have shown that medically tailored meals can improve health metrics. A recent study by the

 investigated health outcomes of medically tailored meals. It found that 62% of clients with hypertension significantly improved their blood pressure and those with diabetes improved their hemoglobin A1c levels when receiving these meals for at least two months, indicating that their diseases may be better managed through proper nutrition. Also, 88% of those with obesity decreased their body mass index or ensured it remained stable. In 

, researchers estimated that in Pennsylvania, increasing access for at-risk patients could save $4,370 per patient annually in health costs.

Another study showed that providing medically tailored meals for those with diet-sensitive conditions and activity limitations could save $13.6 billion in national healthcare costs, averting 1.67 million hospitalizations annually.

Drugs approved by the FDA undergo rigorous testing. “People go to the pharmacy and don’t question [quality] because it’s approved,” Sue Daugherty, R.D.N., L.D.N., CEO of MANNA, an organization providing these meals to people with serious illnesses, says. “With medically tailored meals, anyone can say they’re doing it and there’s no regulation on what that means.” There has been some controversy, however. Some medically tailored meals have been marketed as “dietitian approved,” including meals marked as “heart healthy” or “renal friendly,” that contain high levels of saturated fat, sodium and additives.

Gaining accreditation can assure payers and patients that the food includes nutritious components in the right quantities. “There has to be some type of regulation showing you’re getting what you were prescribed,” says Daugherty. MANNA was 

 by the Food Is Medicine Coalition last month. The coalition is a nonprofit national collective of agencies providing medically tailored meals. The accreditation is rigorous, Daugherty says. During the accreditation process, meals are tested; for a renal diet, the testing measures how much phosphorous, potassium and sodium are in a meal, for example. Also, patients and the program must have access to dietitians.

MANNA has been providing patients with medically tailored meals since 2005. In 2023, they served meals to patients with 85 different illnesses. Diabetes is the disease required for most people entering the program. “Our research shows that we have [the] most impact on superutilizers — the 5% who cost the healthcare system 50% of the [healthcare] cost,” she says. These patients have complex needs. She is seeing an increase in patients with high-risk pregnancies or heart diseases receiving meals for whom low-sodium diets are recommended.

Standardizing how to identify a person’s social risk factors and using validated screening tools are important to appropriately refer patients to community-based providers, Denise Diaz Payán, Ph.D., M.P.P., an associate professor at the University of California Irvine Joe C. Wen School of Population & Public Health, says. “People are using all kinds of screening tools at their convenience,” she says. “You’ll hear feedback from facilities that they don’t have time, they don’t have a person to do the screening.”

Medically tailored meals are an appealing idea, but there is little regulation or standardization.

Clinical

A Key Ingredient to ‘Food is Medicine’: Standardization

The Cigna Group released their revenue report for 2024 which showcased their 27% revenue jump to $247.1 billion — with Evernorth much to credit.

Evernorth, which includes pharmacy benefit services such as Express Scripts, contributed to the increase that clocked in at $195.3 billion in 2023.

David M. Cordani, chairman and CEO of The Cigna Group, highlighted Evernorth’s contributions during a conference call discussing the results.

“Evernorth continues to drive strong results in line with our expectations, primarily driven by our specialty and care services segment,” Cordani said.

The numbers highlight this statement, with pharmacy benefit services reaching $111.8 billion in adjusted revenue, a 46% jump from $76.8 billion in 2023.

Cigna's 27% Revenue Increase in 2024 and the Outlook on 2025

In addition, specialty and care services recorded $90.3 billion in adjusted revenue, marking an 18% increase from the previous year.

Evernorth's growth pattern has remained consistent, establishing itself as the backbone of Cigna’s financial performance.

As Cordani noted, Evernorth's leadership in biosimilars plays a crucial role in addressing major healthcare challenges.

For instance, the company introduced the Humira interchangeable biosimilar last summer, offering eligible patients access at $0 cost. 

By the end of 2024, nearly 50% of eligible Humira prescriptions were filled with biosimilars, and Evernorth is now extending this benefit to the interchangeable Stelera biosimilar.

Over the next five years, Cordani said approximately $100 billion in specialty drug spend in the U.S. will be subject to biosimilar and generic competition, positioning Evernorth to lead the way in delivering significant savings.

He also emphasized the growing need for affordable prescription drugs, especially with the rising use of GLP-1 medications, which have become a major driver of drug spending trends.

While these medications are relatively inexpensive to produce, U.S. patients are paying several times more than those in other countries, even with full pass-through rebates.

By advancing biosimilars and working to reduce drug costs, Evernorth remains committed to ensuring that patients can access medications at fair prices while maintaining long-term sustainability in the healthcare system.

Eric Palmer, president and CEO of Evernorth Health Services, highlighted in a 

, the organization's continued innovation in response to market demands.

"We know that healthcare and prescription drugs need to be more affordable, and coverage needs to be more transparent and less complex," he said.

To further enhance affordability, Evernorth has recently introduced several initiatives focused on cost transparency and patient protections.

These protections ensure that patients benefit directly from the savings Express Scripts negotiates.

For example, patients will no longer pay the high list prices for medications, and those in high-deductible plans will receive the lower prices negotiated by Express Scripts, even during the deductible phase when costs can be highest.

Beyond price protections, Evernorth is increasing transparency by offering personalized reports to patients, detailing their prescription drug costs, negotiated savings and plan-paid amounts.

Plan sponsors will also receive detailed, annual reports that provide greater visibility into pharmacy claims and costs than what is typically offered.

These efforts are part of Evernorth's larger strategy to make healthcare more affordable and transparent for all involved.

Adam Kautzner, president of Evernorth Care Management and Express Scripts, stressed that these initiatives are designed to ensure there are no surprises at the pharmacy counter.

A key factor in Evernorth’s innovation is the data-driven EncircleRx program, which expanded to cover about 8 million lives in 2024, Cordani added.

The program helps plan sponsors reduce costs and improve outcomes, with its Cardiodiabesity solution offering predictability in managing obesity, diabetes, and cardiovascular disease.

It also provides lifestyle support and tools to help patients on GLP-1 medications sustain long-term improvements.

Cordani expressed the importance of these solutions, especially given the rising costs of GLP-1 medications in the U.S.

"Despite these medications being relatively cheap to produce, Americans are paying prices that are multiples higher compared to other countries," he said. "This is not acceptable, nor sustainable."

Formulary Watch

Evernorth Drives Cigna's Strong Revenue Growth and Focuses on Biosimilars and Drug Affordability

A federal program started under President Biden to help state Medicaid programs cover the cost of pricey cell and gene therapies (CGT) is moving forward, after a brief period of uncertainty after President Trump came into office and rescinded a broad list of his processor’s executive orders.

The CGT Access Model aims to address a key challenge for Medicaid programs: how to pay for one-time, multimillion-dollar gene therapies while operating under fixed budgets. The program will initially focus on sickle cell disease, a genetic blood disorder that disproportionately affects Black Americans, and include two recently approved gene therapies: Bluebird Bio’s Lyfgenia (lovotibeglogene), and Vertex Pharmaceuticals’ Casgevy (exagamglogene), according to a December 2024 CMS 

The model operates by allowing CMS to negotiate multi-state, outcomes-based agreements with drug manufacturers. This means that states participating in the program will not only receive the standard Medicaid drug rebates but will also benefit from additional rebates tied to patient outcomes. The program also includes outcomes-based agreements, so that if the treatment does not work as expected, manufacturers may be required to reimburse states for a portion of the cost.

The program was set to start in at the beginning of the year, until President Trump issued a broad 

 on Jan. 20 rescinding a long list of Biden executive actions, including 

 of October 14, 2022,(Lowering Prescription Drug Costs for Americans) that initiated the program. However, an HHS spokesperson told 

 that the program was still proceeding as planned.

Margaret Scott, M.S., M.P.H., a principal at 

, a healthcare consulting firm, said in an interview that the program may provide significant relief for state Medicaid agencies, which traditionally negotiate supplemental rebates individually. Because gene therapy efficacy is measured over a decade or longer, tracking outcomes can pose a challenge when Medicaid patients change coverage due to residential moves, employment status, age or even losing their initial diagnosis if the condition is resolved, she said.

“This is the first time that CMS is negotiating on behalf of states,” Scott said. “So the benefit to states of this program is that the negotiation is centralized at CMS. And in addition, CMS will be doing a lot of the legwork and data aggregation to monitor patient outcomes for these particular gene therapies. So that's relieving some administrative burden on the states.”

President Trump signed an executive order on the day of his inauguration that created doubts about the future of a program that helps state Medicaid programs pay for expensive cell and gene therapy.

CMS Cell and Gene Therapy Access Plan Earns Reprieve After Trump Halt

The murder of UnitedHealthcare CEO Brian Thompson on Dec. 4, 2024, was shocking enough for the company and the health insurance industry in general. But some of the reaction to the events cuts even deeper. The lionization of the alleged murderer can be dismissed as warped, another example of social media-fueled outrageousness. But offline, more quietly and with some thought, many people navigated to a mixed middle ground that went something like this: “Of course, I am not in favor of murder and violence. It’s terrible. But I understand that people are angry at the health insurance industry.”

Health insurers and others in the healthcare sector took notice of the anger and frustration, tried to make sense of its origins and discussed how health insurers might respond.

“I think industrywide, people are taking [a] hard look at ourselves and self-reflecting and asking questions like, ‘How do we be a better industry?’” Sachin Jain, M.D., MBA, president and CEO of SCAN Health Plan, a not-for-profit Medicare Advantage plan in Southern California, says.

Even Andrew Witty, CEO of UnitedHealth Group (the parent company of UnitedHealthcare) and Thompson’s boss, discussed the negative sentiments that welled up. In an op-ed piece about Thompson in 

 Witty wrote about the “grief and sadness we will carry for the rest of our lives” but also of the “struggle to make sense of this unconscionable act and the vitriol that has been directed at our colleagues.”

Even before Thompson’s murder and its aftermath, Gallup polling showed growing discontent with American healthcare coverage and the quality of U.S. healthcare overall. According to results of the company’s annual Health and Healthcare poll that was conducted in November 2024, only 28% of the respondents indicated that their coverage is excellent or good, 4 percentage points lower than the average since 2001 and well below the high point in 2012 when 41% put their coverage in the excellent or good category. The same poll showed that fewer than half (44%) of U.S. adults say the quality of healthcare in the country is excellent (11%) or good (33%), and that proportion has slid 10 percentage points since 2020.

Ideas about how to remedy problems are shaped by notions about what caused them, and the thinking about addressing the negative views of and experience with U.S. health insurance is no exception.

Ryann Hill, M.P.H., who founded her own lobbying firm, Indigo Hill Strategies, in the past year in Washington, D.C., is no stranger to healthcare policies and politics. Her experience holding government affairs positions for a variety of healthcare organizations, including SCAN Health Plan, stretches back almost 10 years. Hill sees the anti-health insurance thoughts and feelings in the U.S. as yet another manifestation of the worldwide rise in populism. “We’ve seen this rise in anticorporate, anti-big business sentiment, and that sentiment is the through line,” Hill says.

Hill says the U.S. healthcare system is so complex that it’s impossible to pinpoint any specific reason for the frustration that people may be feeling. “But we’re always going to have this underbelly of the everyday person versus big business.”

Populism is also part of François de Brantes’ diagnosis of the discontentment. “What’s the rise of populism?” de Brantes, MBA, a member of the 

 editorial advisory board who has decades of experience in the payer-managed care realm, asks. “The rise of populism is essentially saying I have no control in many different aspects of my life and I have degrees of freedom in other aspects of my life and then there is this stuff out there, which essentially seems unaccountable.”

Changing the narrative about health insurance.

Marge Ciancetta

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