C-SNP Surges, Lilly Sales Rise 45%, UHC’s Phone Call W/ Surgeon Mid-Procedure

Hey all,

Happy Thursday! I especially want to learn more about the UHC story about forcing a surgeon to leave mid-procedure to get an overnight stay covered. I wish I had access to a transcript of this conversation and the contempt that surgeon must have shown at what, from the surgeon's point of view, seems ridiculous. Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(MMI+) C-SNP Enrollment Surge in 2024 

Chronic Condition Special Needs Plan (C-SNP) enrollment saw a dramatic 61% increase from December 2023 to December 2024, far outpacing the slowing 6% growth in the Dual-Eligible SNP (D-SNP) market. This surge follows years of stagnation and suggests growing interest in specialized Medicare Advantage plans, with major enrollment concentrated in states like Florida, Texas, and California. Notably, some large Medicare Advantage (MA) markets—such as Pennsylvania, Ohio, and New York—have minimal C-SNP presence, indicating untapped potential. UnitedHealth and Humana continue to dominate, but smaller players like Alignment, GuideWell, and Zing experienced rapid growth. Market concentration varies widely, with some states seeing near-monopolies while others have competitive landscapes. Full Article

(Endpoints News) Eli Lilly’s 45% Sales Jump and Pipeline Cuts

Eli Lilly reported a 45% increase in fourth-quarter revenue to $13.53 billion but fell short of expectations due to weaker-than-anticipated sales of its obesity drug Zepbound. The company reaffirmed its 2025 revenue forecast of $58 billion to $61 billion while continuing to compete with Novo Nordisk in the lucrative obesity drug market. To stay ahead, Lilly investing heavily in manufacturing and battling compounding pharmacies. Lilly also announced the termination of four drug programs, including an obesity treatment, an Alzheimer’s drug, a heart failure candidate, and an eczema therapy, while increasing R&D spending by 18%. Full Article

(Benefits Pro) Surgeon Leaves Mid-Procedure To Get Stay Covered By UnitedHealthcare 

A surgeon’s viral account of having to scrub out mid-surgery to call UnitedHealthcare for insurance approval has sparked widespread debate and legal threats. Dr. Elisabeth Potter claims she was forced to take the call to secure an overnight hospital stay for her patient, despite the procedure being preapproved, while UnitedHealthcare asserts that the issue arose from an administrative error. The insurer has since sent a cease-and-desist letter demanding a retraction, leading to accusations of corporate bullying and patient risk. Full Article