UnitedHealth Is The Unpayer, CEOs Pocket Your Copays, and Biosimilars Are Still Somehow More Expensive

Hey all,

Happy Thursday! The government is ironically the only player in healthcare with a real profit motive—healthy kids grow up to pay more taxes, and healthier adults keep paying them longer—yet it consistently fails to act in its own financial interest. Instead of investing heavily in infant nutrition or preventative care, which would clearly pay off down the line, it treats those areas like afterthoughts. Americans want affordable healthcare, and the irony is there’s a market-based case for it—just one where the government finally acts like a rational economic player instead of dodging anything that sounds too much like the “S” word.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(BenefitsPro) UnitedHealth Accused of Building a Private ‘Single-Payer System’

Sen. Bernie Sanders criticized UnitedHealth for acquiring over 2,700 health care companies, suggesting the insurer is building a private “single-payer system” that benefits shareholders rather than patients. The Senate HELP Committee hearing spotlighted concerns over vertical integration and lack of data transparency, with experts highlighting insurers’ ability to bypass ACA spending rules and employers’ limited access to claims data despite bearing financial risk. But let’s be clear—UnitedHealth isn’t a single payer; they’re just the sole source provider of a very specific kind of agony that only UHC members truly understand. Full Article.

(HEALTH CARE un-covered) Health Insurer Profits in 2024

In 2024, the seven largest publicly traded U.S. health insurers posted a record-breaking $71.3 billion in profits while their CEOs collectively earned over $146 million, even as millions of Americans struggled with unaffordable care and rising out-of-pocket costs. The article highlights how insurers boosted revenue through premium hikes, government overpayments, and vertical integration across Medicaid and Medicare Advantage, all while limiting access to care through restrictive policies. That $146 million could’ve covered a full year of Mounjaro for 24,000 people—but hey, better we all jump through hoops for medically necessary meds so the CEOs can hit their stock price targets. Full Article

(Drug Channels) Buy-and-Bill Biosimilars Market Dysfunction

 Despite years of mandated pricing transparency, hospitals and insurers continue to extract high markups and allow inconsistent reimbursement for biosimilars, undermining their cost-saving potential. New analysis shows 340B hospitals especially benefit from steep markups, insurers pay drastically different rates for the same drug, and in some cases, biosimilars are reimbursed more than their branded equivalents—leaving plan sponsors and patients to shoulder inflated costs. But then again, you can’t expect a BUCA PBM to pass up the chance to twist a good idea into yet another profit machine. Full Article