Insights

Original research, studies and thought leadership pieces relevant to the regulated markets business.

perspectives

AHIP Continues to Raise Awareness of Cost Impacts if Congress Fails to Extend ACA Health Care Tax Credits

AHIP highlighted multiple media reports this week noting that millions of Americans are getting “their first look at the sharp increases many will pay” if Congress fails to extend the enhanced premium tax credits that have made comprehensive, high-quality health care coverage affordable for 22 million Americans. The Associated Press reports that the expiring subsidies means […]
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November 13, 2025

marketplace

survey results

AHIP/BCBSA Release New NSA Findings

On Oct. 24, AHIP and the Blue Cross Blue Shield Association (BCBSA) released findings from their 2024 No Surprises Act (NSA) survey, which revealed that nearly 40% of surprise billing disputes submitted to the federal Independent Dispute Resolution (IDR) process in 2024 were ineligible under the NSA. More than half of these ineligible disputes still […]
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November 13, 2025

EGWP marketplace medicaid Medicare

Solutions

The M3P Solution is Making Waves!

On Jan. 1, 2025, Express Scripts successfully launched the M3P solution to nearly all Medicare Health Plan clients – plus the entire EGWP line of business. By the end of Q4, an impressive 76,744 members had opted in. We’re proud to lead the industry in repayment rates, with 96% of members paying their billed amounts […]
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November 13, 2025

EGWP Medicare

Initiatives

Policymakers Join Grand Opening of State-of-the-Art Evernorth Specialty Care Facility in Delaware

On Oct. 29, Evernorth celebrated the grand opening of its largest and most advanced specialty pharmacy and distribution facility in the United States. Each year, the new Newark, DE facility is expected to dispense 1.5M specialty prescriptions from Accredo and distribute 200,000 orders of complex medications from CuraScript SD, improving access for patients with chronic […]
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November 13, 2025

EGWP marketplace medicaid Medicare

event

Regulated Markets Summit Recap

At the 9th annual Regulated Markets Summit, Evernorth leaders and industry experts discussed challenges and opportunities in today’s complex regulatory health care environment. They provided actionable insights for key topics related to drug pricing policies, benefit design, Quality and Star Ratings and CMS audits. Want to learn more? Please reach out to your Evernorth strategist […]
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November 13, 2025

marketplace medicaid Medicare

perspectives

PCMA Highlights Recent Pro PBM Comments

PCMA recently highlighted several op-eds from policy analysts and economists who have spoken out on the value of PBMs. Satya Marar, visiting postgraduate fellow at the Mercatus Center at George Mason University, explained in a CounterPunch op-ed why PBMs are necessary to push back against the high list prices that drug companies alone set: “We’d […]
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September 9, 2025

EGWP marketplace medicaid Medicare

perspectives

New Report Finds Pharma-Backed Provision in Tax Law Likely to Cost Far More than Previously Estimated

The Campaign for Sustainable Drug Pricing (CSRxP) recently spotlighted a report by the The Wall Street Journal (WSJ) that a pharma-supported policy in the One Big Beautiful Bill Act is likely to cost seniors and taxpayers far more than previously estimated. The policy was based on a bill called “The Optimizing Research Progress Hope And […]
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September 9, 2025

EGWP marketplace medicaid Medicare

Solutions

CASMB Sends Letter to Administration Opposing Private Equity Firm’s IDR Application

The Coalition Against Surprise Medical Billing (CASMB), which represents employer groups, unions, and health insurers, sent a letter to the Trump administration strongly opposing a recent application by a private equity firm to become a Certified Independent Dispute Resolution (IDR) Entity under the terms of the No Surprises Act. In the letter, CASMB writes that Guidehouse Inc., which […]
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September 9, 2025

EGWP marketplace medicaid Medicare

perspectives

Advocacy Organizations Push Back Against House-Passed Medicaid Cuts

Following the release of the Senate Finance Committee’s reconciliation package, the Modern Medicaid Alliance and more than 190 leading health care organizations said they are “deeply concerned” with the proposal to further cut Medicaid. Their letter to Senate Majority Leaders noted, “The proposals released yesterday go even further to undercut the program…Rather than upholding President […]
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July 9, 2025

medicaid

perspectives

AAF Analyzes Financial Burden of a Single-Payer System

American Action Forum (AAF) recently published insights into the potential costs of changing the U.S. health care system to a single-payer system, sometimes referred to as “Medicare for All” (M4A). Over the past decade, numerous Democrats have proposed that patients would be “better off” with a single-payer system, where the federal government is the sole […]
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April 9, 2025

EGWP marketplace medicaid Medicare

survey results

McLaughlin Poll Finds Voters Oppose Government Intervention in the Private Market

PCMA released results from a public opinion research conducted by McLaughlin & Associates showing that American voters in battleground states overwhelmingly oppose policies that interfere with the private market and believe drug companies should be held accountable for high drug prices. The survey found that 94% of battleground state voters are concerned with the high […]
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April 9, 2025

EGWP marketplace medicaid Medicare

survey results

New Research Finds Direct-to-Consumer (DTC) Pharmaceutical Advertising Costs U.S. Taxpayers Billions of Dollars

As reported in Politico, a new analysis by CSRxP finds that limiting or taxing DTC ads could increase federal revenue by up to $1.8 billion annually. The analysis is based on the potential tax impact if advertising expenses were not tax-deductible as they are today. The research found that 10 of the largest pharmaceutical manufacturers […]
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April 9, 2025

EGWP marketplace medicaid Medicare

survey results

AHIP Releases Nationwide Poll Showing Strong Satisfaction with Employer-Provided Coverage

AHIP’s Coverage@Work released the results of a new nationwide poll that found strong satisfaction with employer-provided coverage. A growing majority of consumers (75%, up 12% since April 2023) are satisfied with their current employer-provided coverage and 74% prefer to get their coverage through their employer. Plan satisfaction is driven by the comprehensive coverage (49%), affordability […]
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December 10, 2024

marketplace

survey results

Lown Institute Study Finds Unnecessary Back Surgeries Cost Medicare $600 Million Annually

A new analysis from the Lown Institute, an independent think tank, found that hospitals performed more than 200,000 unnecessary back surgeries on Medicare beneficiaries in the U.S. over three years. Roughly $2 billion was spent on the “low value” procedures while patients were put at risk of poor outcomes, researchers wrote. The researchers looked at […]
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December 10, 2024

EGWP Medicare

Solutions

Medicare Prescription Payment Plan (M3P) Educational Overview

With Open Enrollment right around the corner, Medicare eligible members can begin opting in to the Medicare Prescription Payment Plan (M3P). Discover more about the M3P program and how Express Scripts by Evernorth supports clients with a solution. Watch now: https://bit.ly/47yF5vf
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October 8, 2024

Medicare

Solutions

Learn how Express Scripts by Evernorth can help plans succeed in the complex world of government-regulated health care

The world of Regulated Markets is constantly changing. Express Scripts by Evernorth offers the expanded capabilities you need to succeed in today’s regulated space by turning insightful data into innovative solutions that drive affordability and opportunities for better member outcomes. Watch now: https://bit.ly/3swVK23
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October 8, 2024

marketplace medicaid Medicare

Guidance

Inflation Reduction Act (IRA) Educational Resources

As a means of providing additional support to our clients, the following videos and companion guides have been created to provide education and awareness to agent/brokers and customer service. This content is designed to be an educational resource for these key stakeholders to highlight recent and upcoming changes to the Medicare Part D program. This […]
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August 21, 2024

Medicare

perspectives

What impact will the Inflation Reduction Act have on health plans?

Plan sponsors should be aware of the effects the law will have on Medicare Part D over the coming years.
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March 6, 2024

EGWP marketplace medicaid Medicare