Seniors Can't Afford Their GLP-1s, Doctors Can't Afford Independence, and PBMs Can't Afford Regulation

Hey all,

Happy Monday!  I took last week off for the Jewish holidays. Spent time with family, reflected on the year, and calculated exactly how many hours I wasted fighting my insurance company for care I actually needed. (Spoiler: it was too many.) Here's to making this the year we fix that particular absurdity.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(MedPage Today) GLP-1 Scripts for Seniors and Prior Authorizations

A new study in JAMA found that nearly all Medicare Part D plans now require prior authorization for GLP-1 receptor agonists, with out-of-pocket costs for seniors nearly doubling in 2025 due to higher coinsurance rates. Researchers linked this shift to changes under the Inflation Reduction Act, which increased plan liability for costly drugs, incentivizing insurers to restrict coverage and shift costs to patients. GLP-1s may have been deemed “too expensive for obesity,” but with rising diabetes rates and mounting policy pressures, CMS could soon face the irony of them being “too expensive for diabetes” as well. Full Article

(Healthcare Huddle) Physician Practice Consolidation: Market Power Reshaping Healthcare

A new GAO report highlights the accelerating consolidation of physician practices, with hospitals, insurers, and private equity firms increasingly dominating ownership while independent practices shrink to just 42%. This shift, driven by economic pressures, regulatory policies, and burnout, is reshaping medicine by raising costs, reducing physician autonomy, and creating concentrated healthcare markets with unclear benefits for patients. But hey, at least it explains why it’s nearly impossible to find a primary care doctor near me who isn’t employed by Optum—since they basically bought them all. Full Article

(Bloomberg) Drug Middlemen Aim to Avoid New Rules With Voluntary Changes

 Pharmacy benefit managers (PBMs) are proposing voluntary reforms—like capping patient drug costs at pharmacy cash prices, promoting lower-cost biologic alternatives, and supporting rural pharmacies—to stave off new federal regulations from the Trump administration. The strategy follows a similar playbook used by insurers earlier this year to deflect oversight, though critics argue PBMs could have made these changes long ago and shouldn’t be trusted to self-regulate given their dominance over 80% of the market. After all, PBMs and their health insurer owners have a long tradition of announcing big changes that don’t actually change much—except, of course, their ability to avoid being regulated. Full Article