340B Sarcasm, Interview W/ A Broker, & United Health’s Tough Year

Hey everyone,

Happy Tuesday! I found the interview with benefits broker Lester Morales particularly interesting, especially this quote: “What tools do they have to understand that they can get knee surgery for $25,000 or $62,000? If my $5,000 deductible is going to be hit whether I go here or there, if they pay the same amount, I don’t care as a consumer.”

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(The Healthcare Breakdown) Breaking Down Those Sweet 340B Discounts 

Preston Alexander dives into how 340B works with a touch of sarcasm. Once a targeted program for helping underserved patients, it has become a cash cow for large hospital systems and contract pharmacies. With hospitals buying drugs at steep discounts, billing insurers full price, and keeping the spread, it’s no surprise that participation has skyrocketed. Add in contract pharmacy arrangements and PBM involvement, and you’ve got a system where everyone—except the patient—seems to win. As consolidation accelerates, so do the profits, while the original intent of 340B drifts further into the background. Full Article.

(HEALTH CARE un-covered) Interview with Lester Morales on Health Care Reform

In this interview, Lester Morales, CEO of Next Impact, shares how his family’s financial devastation from medical debt drove him to challenge the traditional health insurance system. He discusses the flaws of Big Insurance, the benefits of self-funding and reference-based pricing, and the need for transparency in health care costs. Morales emphasizes the importance of educating employers and employees on cost-saving alternatives and how hospitals are increasingly open to direct contracting. His insights highlight a growing movement toward fairer, more sustainable health care solutions. Full Article.

(Modern Healthcare) UnitedHealth Group’s Year of DOJ Probes, Layoffs, and Backlash)

UnitedHealth Group (UHG) navigated a tumultuous year marked by federal investigations, rising medical costs, scrutiny over its OptumRx pharmacy benefit manager, and consumer frustration over claims denials. The company also dealt with the catastrophic Change Healthcare cyberattack and the tragic murder of UnitedHealthcare CEO Brian Thompson. Despite these challenges, UHG reported record-high annual revenue of $400.3 billion, though net earnings dropped 34.1% to $15.2 billion. It also secured higher Medicare Advantage star ratings and projected membership growth while competitors scaled back. Full Article.