CMS Innovation Project May Bypass Obesity Drug Ban (Maybe), Remote Monitoring Startups Ruin It for Everyone, Elevance Makes Facilities Eat the Cost of Out-of-Network Care

Hey all,

Happy Tuesday! We've known the system is broken for years, but change moves at glacial speed while the grift continues. Cigna's owned generic supplier has been charging inflated prices under the guise of "quality," Congress is still debating ACA subsidies for insurance that hasn't made healthcare affordable instead of considering direct payment approaches, and it took the FDA two decades to reverse a hormone therapy warning despite mounting evidence. A vocal minority keeps pushing radical ideas like actually paying for care instead of middlemen, but apparently we'd rather spend another decade studying the problem while big health insurers shuffle money between their own subsidiaries.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Bloomberg) Cigna’s Generic Drug Pricing Exposed

A new report by 46brooklyn Research reveals that Quallent Pharmaceuticals, a Cigna-owned unit, often sells generic drugs at significantly higher prices than competitors, raising concerns about conflicts of interest in Cigna’s dual role as both drug seller and pharmacy benefit manager. While Cigna claims it ensures quality and denies misleading pricing practices, the analysis suggests that higher average wholesale prices (AWP) could drive up costs for health plans, reinforcing critics' concerns about opaque pricing and vertical integration in the drug supply chain. PBMs love to claim they don’t make money—until you notice they’re just shuffling dollars between their own companies under the guise of “quality” and somehow always landing on the pricier option. Full Article

(Healthcare Dive) Government Shutdown & ACA Subsidies

The Senate has taken a significant step toward ending the longest U.S. government shutdown by advancing a spending bill that omits the extension of expanded Affordable Care Act subsidies, with eight Democrats crossing party lines to support it. While the move could restore operations and back pay for federal workers, it delays any resolution on health coverage for millions, risking a sharp rise in insurance costs and coverage loss if enhanced subsidies expire at year’s end—an outcome that may carry political consequences in GOP districts ahead of midterms. While the ACA was a well-intentioned mess held together by copays and wishful thinking, we need a full system overhaul—so far we've gotten some executive elbow grease, but without Congress, it’s like trying to perform heart surgery with salad tongs. Full Article

(STAT News) FDA Reverses Black Box Warning on Hormone Therapy for Menopause:
The FDA has removed its 2003 black box warning from hormone therapy products for menopausal women, citing updated evidence that these therapies offer heart, brain, and bone health benefits. This marks a major policy shift from the agency, which now recognizes that the original warning—based on a narrow interpretation of a 2002 study—discouraged use despite growing data showing hormone therapy’s value when used appropriately, particularly in women under 60. The revised labeling will provide more nuanced, evidence-based information on risks and benefits while maintaining a boxed warning only for endometrial cancer in specific cases. Funny how often you hear men complain, "It's hormonal," like that’s the end of the conversation—well, yeah, it is hormonal, and it’s about time we actually did something productive about it. Full Article