CMS Sanctions Cigna-No More Selling Any New Medicare Advantage Policies Until Algo Problems Denying Medical Coverage and Prescription Denials Are Fixed

As we may all know Cigna is working to be acquired by Anthem, which would be a huge acquisition. As you may or may not know, Cigna’s pharmacy benefit manager now is OptumRX, the PBM subsidiary of United Healthcare. This occurred when Optum purchased Catamaran PBM in 2015 and both have been merged in to OptumRX as the Catamaran name goes away. There’s a lot of this taking place with the zillions of subsidiaries of United Healthcare too, so it making it harder to see the specific subsidiaries and what they do with United in putting money to the bottom line.

If You Are Insured by Cigna, Guess What You Have a New Pharmacy Benefit Manager Named United Healthcare

In addition to make this purchase United had a $10 billion dollar bond sale and who the buyers are, we don’t know.

United Healthcare Having a Big bond Sale to Finance Purchase of Catamaran Pharmacy Benefit Management Company, Huge 10.5 Billion

In other news on the Pharmacy Benefit Manager purchase, Independent pharmacists filed a class action lawsuit against Catamaran. Can you guess why? The independent pharmacists are getting lowballed. They might seem to fit the United Healthcare model of Ingenix, now called Optum Insights that lowballed MDs on payments for 15 years and had many law suits filed against them. Just as a side note, Obama nominated Andy Slavitt to run CMS, and he was the CEO of Ingenix, the low balling company, do we want him at CMS?

United Healthcare Buys Catamaran Pharmacy Benefit Manager Just As the PBM Gets Hit With A Class Action Lawsuit For Low Balling Pharmacy Reimbursements..And More Patient Data to Sell and Analyze For Profit

So with this situation occurring and as I understand it, Cigna signed a 10 year agreement to be the Cigna PBM and it’s about 2 years into the contract. This could make Cigna even more anxious to get the Anthem acquisition take place. When you have a giant insurance competitor now running your pharmacy benefits (OptumRX who also likes to make money with drugs) you have one huge company getting a strangle hold here. If the acquisition of Cigna by Anthem could take place, then the underwriting could change the policies to be at least on paper, underwritten by Anthem and then Cigna could ditch the United Healthcare owned OptumRX. United Healthcare did that a few years ago with buying out the Health Net northeast business, underwrote the policies and let Health Net manage and keep the name, so folks may not have been aware that for a few years, their Health Net policy was underwritten by United Healthcare. The link below is from the archives and explains how this came about over the Tri-Care contract bidding, which is coming up again soon.

UnitedHealthCare Buys a Portion of Health Net in the Northeast

Health Net and Humana File Protests over Military Healthcare Awards to UnitedHealthcare and Aetna

So the real story here is we have the work of expensive quants working on policies today, sometimes stomping all over the actuaries as the quant models are directed at profit as a priority. The machines run the healthcare business anymore. BD

Cigna Corp. announced Friday that it is temporarily banned from enrolling new customers in its Medicare Advantage and standalone prescription-drug plans following an October audit from the US Centers for Medicare and Medicaid Services (CMS).

In a letter dated January 21, the CMS reported that “widespread and systemic failures” at the insurer resulted in customers being denied medical coverage and prescriptions they rightly had access to. After customers filed grievances about being inappropriately denied services, Cigna failed to properly address those complaints, the CMS said.