Lilly Pharm-To-Table Expansion, GOP-Led MA Reform, UNC Sues Insurers Over 340B

Hey all,

Happy Hump Day! I’m a big fan of Medicare Advantage in theory but in practice its being abused by big payors. I’m glad that conservative support for Medicare Advantage reform has emerged as it is a huge boondoggle for the BUCA, with taxpayers and plan members footing the bill. Enjoy the rundown! 

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Cost Curve) Lilly’s Pharm-to-Table Expansion and Adherence Strategy

Lilly has expanded its direct-to-consumer “pharm-to-table” Zepbound offering to include all vial dosages, with a notable pricing model that maintains a $499 refill cost if patients consistently refill within 45 days. This approach not only makes chronic use more affordable but also incentivizes adherence, aligning with broader policy goals around sustained therapeutic use and consumer-friendly drug access. Now if only health plans could get that same $499 price—might be the first time ever that insurers are paying more than cash-pay. Full Article

(HEALTH CARE un-covered) Republican Push for Medicare Advantage Reform

Long-time Republican supporters of Medicare Advantage are now publicly calling out the program's failures, citing systemic abuse by major insurers that harm both patients and taxpayers. This marks a major political shift, as GOP lawmakers and conservative thought leaders—some of whom helped create the program—join Democrats in demanding increased oversight, transparency, and regulation of a system that now costs 22% more per beneficiary than traditional Medicare. With bipartisan momentum building, pressure is mounting on Congress and the White House to confront the insurance lobby and overhaul Medicare Advantage—because it was supposed to help seniors, not help UHC shareholders buy another yacht. Full Article.

(Becker’s Healthcare) UNC Health Sues Aetna, Humana Over 340B Drug Underpayments

UNC Health has filed federal lawsuits against Aetna and Humana, accusing them of underpaying for 340B drug claims at its hospitals between 2018 and 2022, in violation of contractual obligations. The lawsuits argue the insurers improperly applied a federal reimbursement cut later ruled unlawful by the U.S. Supreme Court in 2022, undermining support for hospitals serving vulnerable populations. But let’s be honest—does anyone really think Aetna would’ve underpaid if CVS, its corporate cousin, had been filling those 340B prescriptions? Full Article