Employer healthcare coverage costs are exploding and it is being driven by drug spending. Listen in to hear why employers are concerned and what they will do about it. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses a recent survey that shows employer coverage costs are exploding and it is being driven by drug spending. Employers are very concerned and plan on deploying several strategies to rein in costs. Key Takeaways:   The Business Group on Health’s annual healthcare strategy survey shows employer costs in 2025 will likely grow by as much as 8%. This trend is a major increase from 6% in 2022. Even with plan design changes, trends will exceed the pre-pandemic level. Employer healthcare costs will grow more than 50% since 2017. This trend will persist. Almost all costs are being driven by drug spending. Both price and utilization are responsible. Between 2021 and 2023, the median percentage of health care dollars spent on pharmacy has jumped from 21% to 27%. That is a 14% to 15% annual trend. One of the biggest drivers of increases in drug costs are GLP-1 weight-loss drugs.  Employers are seeing GLP-1s adopted for disease states. Employer coverage also has been one of the few healthcare product segments to extend coverage to those that are just obese or overweight. Seventy-nine percent of employers have seen an increase in interest in obesity medications. About 70% of employers currently cover or will cover (in 2025) GLP-1s for obesity alone. Another 13% are considering it in the future. Other expensive drugs for disease states are also on the rise. Employers will look to rein in costs by going back out to bid and demanding transparent pharmacy relationships. Employers may also rein in the use of GLP-1s. To truly stabilize cost increases for employer coverage, employers should be able to receive the negotiated prices from Medicare drug price negotiations. Connect with MarcMarc on LinkedInMarc on TwitterTHL Podcast ResourcesTHL’s NewsfeedTHL’s Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

A recent study of drug coverage in other developed nations shows that America is not getting the value it needs from its Medicare Part D drug spending.

 

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

 

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

 

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

 

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

 

About The Episode:

 

On this episode, Marc discusses a recent study of drug coverage in other developed nations that proves America is not getting the value it needs from its Medicare Part D drug spending. We need to consider comparative effectiveness and cost-effectiveness of drugs.

 

Key Takeaways:  

America is not getting the value it needs from its Medicare Part D drug spending.

 

Other developed nations look at drugs for comparative effectiveness and cost-effectiveness.

 

In America, our policy is to allow the proliferation of expensive brand drugs without regard to the clinical advancement or cost.

 

A study concluded that more than half of the top 50 Part D drugs would have not received a moderate or high benefit rating from other developed countries.

 

These drugs accounted for $19.3 billion in net spending — 11% of Medicare net Part D costs in 2020.

 

The Medicare Part D drug negotiation law dictates that CMS now consider comparative effectiveness and cost-effectiveness when setting drug prices.

 

This is a very good thing, but we need to ensure such standards apply throughout the healthcare system.

 

 

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

The inability to get your GLP-1 weight-loss drug could be as much about it being in drug shortage as well as how much pharmacies get for dispensing the drug.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

 

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

 

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

 

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

 

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses his exhaustive hunt for his GLP-1 weight-loss drug to treat his diabetes. He found that the inability to get your GLP-1 weight-loss drug could be as much about it being in drug shortage as well as how much pharmacies get for dispensing the drug.

Key Takeaways:  

GLP-1 weight-loss drugs are used to treat a number of disease states as well as weight-loss in general.

 

GLP-1s are very expensive and also in short supply.

 

Americans have a hard time obtaining GLP-1s due to major demand, short supply, as well as how expensive brands are reimbursed.

 

Most chain drug stores and independents could not ensure a consistent supply of my GLP-1 for treatment.

 

In addition to the shortage issue, many of these drug chains and independents were unwilling to aid me because they lost money on every GLP-1 they sold. This occurs on other brand drugs too. The more expensive the drug, the more they lose. This is one of the hidden reasons for the inability to obtain these drugs.

 

Just Walmart Pharmacy had the customer service policy to go the extra mile to help its patients get GLP-1s.

 

Brand drug makers offer few discounts to wholesalers on these drugs and therefore wholesalers offer few discounts to pharmacies.

 

Pharmacies get reimbursed poorly for GLP-1s by pharmacy benefits managers (PBMs), yet PBMs charge health plans and employer groups very high prices.

 

In addition, PBMs do get rebates from brand drug makers for favorable formulary placement of GLP-1s but usually keep all or most of the rebate. The discount is not given to pharmacies, consumers, or employer groups.

 

The only entities making out on GLP-1s and other brand drugs are drug makers and PBMs.

 

This is yet more evidence that we need major drug price reform – negotiation of prices, elimination of rebates, and transparency in the opaque drug supply channel.

 

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

A new study from Third Way shows that hospitals can be more efficient and still make a profit. Hospital reform needs to happen.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

 

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

 

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

 

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses a new study from Third Way that shows that hospitals can be more efficient and still make a profit. Hospital reform needs to happen for the sake of the healthcare systems and consumers.

Key Takeaways:  

A new study from Third Way shows that hospitals can make money at Medicare and Medicaid rates.

 

More than half of hospitals make money on Medicare and about a third on Medicaid.

 

Hospitals charge employer and commercial coverage about 250% of Medicare rates.

 

Hospitals breakeven points on commercial and employer coverage is much lower if hospitals are efficiently run.

 

The more hospitals are bloated and spend, the worse their financial position. The same holds true on quality of care.

 

But hospitals do not want to be efficient. They would rather use their decades old playbook that says they cannot make money from government programs and must charge the commercial world obscene rates.

 

Hospitals are the strongest healthcare lobby and are fighting any type of reform.

 

But with hospitals garnering about 30% of healthcare expenditures, reform is necessary for the systems, employer coverage, and consumers.

 

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

A number of forward-thinking Medicare Advantage executives are advocating for a more accountable and transparent MA program that gives additional value and savings back to the government and enrollees. They are right.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

 

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

 

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

 

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. 

 

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

 

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

 

About The Episode:

On this episode, Marc says a number of forward-thinking Medicare Advantage (MA) executives are right when they advocate for a more accountable and transparent MA program that gives additional value and savings back to the government and enrollees. 

Key Takeaways:  

A number of forward-looking Medicare Advantage executives are proposing reform of Medicare Advantage.

 

They believe being more accountable and transparent is important.

 

Finding a way to give more of the value and savings back to Medicare and enrollees is key.

 

MA plans are currently facing major political and regulatory pressures that hurt their businesses.

 

Greater obstacles are being placed in MA plans’ way.

 

There is reason to believe that MA might have too much of an advantage over traditional fee-for-service Medicare.

 

MA is being heavily criticized for overpayments, risk adjustment, supplemental benefits, and marketing. This needs to be reformed.

 

An accountability and reform agenda in MA could create an MA 2.0, which could usher its growth and prosperity well into the future.

 

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

Big Pharma was crying apocalypse for drug innovation and the industry when Medicare drug price negotiation passed. As is the case with almost every “Chicken Little” declaration, their world and ours did not come to an end. The public just might see some drug price relief.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

 

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

 

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

 

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

 

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

 

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

 

About The Episode:

On this episode, Marc discusses the recently announced Medicare drug prices negotiated for the first ten drugs in 2026. Big Pharma was crying an apocalypse would happen. But as is the case with almost every “Chicken Little” declaration, their world and ours did not come to an end. The public just might see some drug price relief.

Key Takeaways:  

CMS announced drug prices for the first ten drugs in Medicare negotiations for 2026.

 

Big Pharma argued the world would come to an end if the negotiation process passed.

 

The discounts off list prices are between 38% and 79%, but real savings are much less – perhaps about 22%.

 

But this is savings nonetheless for Medicare and enrollees.

 

Still, American consumers will continue pay markedly more than citizens in other developed countries.

 

The negotiations are fair and should grow over time.

 

The drug market is not a free market and the intervention is not unreasonable.

 

Big Pharma companies have told investors the drug price negotiation law will not jeopardize margins.

 

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

The question of whether insurers, especially those with Medicare Advantage, would fare better under a Trump or Harris administration is a tough one. Here are my pros and cons for each candidate from a health plan standpoint.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

 

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

 

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

 

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

 Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

 

On this episode, Marc discusses whether insurers, especially those with Medicare Advantage, would fare better under a Trump or Harris administration. The question is multi-faceted and is a tough one. He discusses the pros and cons for each candidate from a health plan standpoint.

Key Takeaways:  

The question of whether insurers, especially those with Medicare Advantage, would fare better under a Trump or Harris administration is a tough one.

Here are my pros and cons for each candidate from a health plan standpoint.

Trump is more friendly to private health plans and delivery.

 

He is a strong proponent of Medicare Advantage and supports its growth.

 

However, Trump is anti-coverage expansion, which impacts plans’ growth in the future. He could take an axe to Medicaid and the Exchanges.

 

Enhanced premium subsidies in the Exchange would die under Trump in 2026.

 

Harris is pro-coverage expansion and would continue to expand Medicaid and

the Exchanges.

 

She would advocate for the continuation of enhanced premium subsidies in the Exchange.

 

However, Harris has a mixed record on support for private health plans and delivery.

 

Harris and the Democrats are less supportive of Medicare Advantage and would likely reduce revenue and the scope of the program.

 

Anti-trust investigations and close scrutiny of plan and provider consolidations would occur under Harris.

 

Both candidates could be forced to target MA for some reductions and continue drug price reforms.

 

So, it is a mixed bag. Trump is a greater proponent of private health plans but anti-coverage expansion. Harris is less enamored with private health plans but pro-coverage.

 

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

Some major benefit cuts and premium increases in Medicare Advantage and Part D could shock Medicare enrollees and the public in the upcoming enrollment season and lead to an October Surprise for Democrats.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the fact that some major benefit cuts and premium increases in Medicare Advantage and Part D could shock Medicare enrollees and the public in the upcoming enrollment season and lead to an October Surprise for Democrats.

Key Takeaways:  

The changes to the Part D program in the Inflation Reduction Act (IRA) have created huge new costs for Medicare Advantage (MA) and standalone Part D (PDP) plans.

As well, MA plans saw falling rates, lower Star scores, new regulations, and other increased costs for 2025.

MA plans likely will cut benefits and increase premiums in 2025.

Standalone PDP plans are looking at huge premium increases for 2025.

The new benefits and premiums are advertised in October -- right before the November election.

About 57 million Americans have to make new plan choices in October.  They rely on friends and loved ones to help them.

The bad news on benefits and premiums could be learned by 45% of voters close to the election.

The fallout was entirely predictable.  The government did not fund the Part D changes it passed and essentially shifted costs to plans and the enrollees.

The IRA was very much too good to be true on Part D.

The fallout could be an October Surprise for Democrats at election time.

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

With vital agent-broker compensation reform now stayed by a federal judge, CMS and Congress need to work together to pass these needed reforms. The status quo hurts Medicare Advantage and enrollees.

Episode Teaser:

With vital agent-broker compensation reform now stayed by a federal judge, CMS and Congress need to work together to pass these needed reforms. The status quo hurts Medicare Advantage and enrollees.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the vital agent-broker compensation reform that was stayed by a federal court judge. The reforms were important for integrity in the enrollment process and to safeguard Medicare Advantage. CMS and Congress need to work together to pass these needed reforms.

Key Takeaways:  

Steerage deals between big Medicare Advantage plans and big brokers and marketing organizations hurt the integrity of the enrollment process.

Many complaints came in and members were enrolled in plans that were not in their best interests.

CMS tried to overhaul the system, but earlier changes were inadequate. A new rule would have capped overall compensation and banned incentive deals that steer members to plans.

A federal court struck down the rule as arbitrary and beyond CMS’ scope.

CMS and Congress should get together to legislate the changes. It is very important to ensure integrity in the enrollment process and not hurt MA’s value.

Meanwhile, some firms see the writing on the wall and are beginning to reform themselves and build transparent ways to show enrollees the best plans for them.

Technology will play a big role in taking opaqueness and complexity away.

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

 

Opponents of Medicare Advantage (MA) have opened a new line of attack on the program, arguing supplemental benefits are more of a marketing scam than a true value. MA plans need to take the issue very seriously and reform their programs.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

 

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

 

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

 

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

 

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

 

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

 

About The Episode:

On this episode, Marc discusses the need for Medicare Advantage (MA) plans to reform how they approach supplemental benefits. Opponents have opened a new line of attack on the program, arguing supplemental benefits are more of a marketing scam than a true value. 

Key Takeaways:  

Opponents of the program, CMS, and Capitol Hill are very focused on overpayments in Medicare Advantage (MA).

But a new line of attack has opened on supplemental benefits, with arguments that supplemental benefits are more of a marketing scam than a true value.

CMS has liberalized the kinds of supplemental benefits that can be offered.

Supplemental benefit offerings have proliferated over the years but no one knows if what is submitted in bids as expected utilization represents what is truly utilized.

There are numerous reasons for this, including no submission of supplemental benefit data to the encounter data system.

Both the GAO and MedPAC have raised issues.

Opponents, too, are firing up their objections.

CMS has issued two reforms in response and to ensure better oversight, including mandatory submission of supplemental benefits to the encounter system as well as outreach and notification of members on the availability of the benefits.

MA plans need to take the issue very seriously and reform their programs. They need to drive utilization to show the real value.

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Marc on LinkedIn

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance