CMS Should End Prior Auth, Obesity Med Disparities, & Devoted Health Outperforms Competition

Hey all,

Happy hump day! Everytime I see a prior authorization regulation or law I pray it is passed. PAs are the bain of my existence and a plague upon the US healthcare system. Enjoy the rundown! 

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Bloomberg) CMS Explores Limits on Prior Authorizations

The Centers for Medicare and Medicaid Services (CMS) is considering new rules to reduce insurers' reliance on prior authorizations, a common practice that often delays patient care and frustrates providers. The agency aims to standardize requirements, automate decisions, and potentially enforce changes through regulation amid growing public outrage over opaque and burdensome approval processes. Prior authorization, it turns out, isn’t so much about appropriate care—it’s more like insurance companies challenging doctors to a paperwork marathon and seeing who gives up first. Spoiler: it's usually the patient. Full Article.

(JAMA) Disparities in Obesity Medication Prescriptions

A comprehensive study published in JAMA found that fewer than 3% of eligible adults were prescribed semaglutide or tirzepatide for obesity from 2020 to 2024, with notable disparities by race, ethnicity, gender, socioeconomic status, and geographic location. Despite increasing overall prescription rates, groups such as men, Hispanic and Asian individuals, rural residents, and those in high social vulnerability areas were consistently less likely to receive these medications, highlighting persistent access barriers—all while you still can’t get your semaglutide or tirzepatide prescription filled on the Upper East Side or in SoHo because everyone and their Pilates instructor already has one. Full Article

(Endpoints News) Devoted Health’s 2024 Financial Performance

Devoted Health significantly reduced its operating losses to $9.9 million in 2024 while nearly doubling both its Medicare Advantage membership and revenue, which surged 69% to $3.3 billion. This growth comes despite industry-wide struggles with rising medical costs and reduced government reimbursement, highlighting Devoted’s effective cost management and positioning it as a standout among startup insurers in a turbulent market. Its improved performance and net gain of $20.7 million were buoyed by investment income and reflect growing investor confidence, though full financials remain partially opaque due to the nature of regulatory filings. Full Article