340B Gets Blamed For Premium Hikes, GLP-1s Blamed For 9% Employer Cost Increase, Aetna+Optum Pay $8.4M To Settle 'Dummy Code' Lawsuit

Hey all,

Happy Tuesday! I’m constantly surprised that employers continue to use BUCAH PBMs and TPAs when they have a long track record of driving up costs. Do they expect them to suddenly flip their business model and act like fiduciaries? If you believe that I have some magic beans I’d like to sell you…

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(SAGE Journals) 340B Program’s Impact on ACA Premiums

A longitudinal study (2018–2022) found that higher 340B hospital site density was associated with a 1.8% rise in ACA benchmark premiums, equating to $106 more per subsidized enrollee annually and about $2.2 billion in additional taxpayer-funded subsidies. However, this conclusion rests on a flawed assumption that 340B was designed to lower premiums or patient costs, when in fact its statutory purpose is to fund safety-net hospitals and expand access for underserved populations; without requirements for hospitals to pass savings to patients, measuring its success by premiums risks misinterpreting the program’s intent. Of course, it would be lovely if 340B hospitals could just wave away copays without tripping over anti-kickback laws—maybe someday in an alternate regulatory universe. Full Article.

(HR Brew) Employers Health Costs Rise 9%

U.S. employers expect healthcare costs to increase by a median of 9% in 2026, driven in part by the rising use of costly GLP-1 obesity and diabetes medications, according to a Business Group on Health survey. Rather than dropping coverage, most HR teams plan to renegotiate contracts, replace underperforming vendors, and tighten eligibility rules to manage expenses, highlighting growing pressure to balance employee health needs with financial sustainability. And hey, if the Business Group on Health ever staged a mass breakup with the BUCAH PBMs, that’d be the first time in history a corporate divorce actually saved everyone money. Full Article

(Fierce Healthcare) Aetna and Optum 'dummy codes' Case

Aetna and Optum have agreed to pay nearly $8.4 million to resolve a class-action lawsuit alleging they improperly used "dummy codes" to pass administrative costs onto patients, inflating out-of-pocket expenses for more than 256,000 people. The case, first filed in 2015 and overturned on appeal after an initial dismissal, underscores growing scrutiny of insurer billing practices and the potential financial burden of opaque coding on patients. Who could have possibly guessed it would only take ten years and multiple appeals for Optum to finally settle? Full Article