Talking Points: 13 January 2025

A roundup of the issues driving the healthcare conversation with data and insights to support you as a Health Action Network advocate.

Week in Review

 RX PRICES Drug companies raise prices on hundreds of products.

Quick takeaway: Drug companies kicked off the New Year by hiking prices on over 250 drugs.

Digging deeper: According to a new analysis, the median price increase comes in at 4.5 percent, well over the 2.7 percent rate of inflation. The drugs included in this first wave of price hikes include COVID treatments and vaccines.

Pfizer raised prices for the most products on the list at over 60 drugs. Elsewhere, Bristol Myers raised the prices on a pair of its already expensive cancer cell therapies by 6 percent and 9 percent, respectively.

A separate report released last month took a closer look at five widely used prescription medicines that had undergone significant price increases in 2023, totaling $815 million without any improved clinical value.

MEDICARE ADVANTAGE Cuts to Medicare Advantage impact millions of seniors.

Quick takeaway: Data shows that two successive years of cuts to the Medicare Advantage (MA) program have increased costs and reduced benefits for seniors enrolled in MA plans across the country.

Digging deeper: Several recent analyses underscore the impact of these cuts:

• Fewer options
  • Over 60 percent of Medicare beneficiaries now live in counties with fewer MA plans in 2025 than in 2024
  • Almost 2 million MA enrollees were forced to choose new coverage for this year
• Higher out-of-pocket costs
  • At least 18 states saw more than a 10 percent increase in average MA premiums
  • The median maximum out-of-pocket levels are up 8 percent from last year
• Reduced supplemental benefits
  • The share of general enrollment plans offering an over-the-counter benefit fell from 86 percent last year to 73 percent in 2025
  • Offerings of nutritional benefits decreased from 40 percent of general enrollment plans to fewer than 30 percent

What it means: 33 million Americans – 54 percent of Medicare-eligible enrollees – now choose MA for its unique focus on coordinated care and whole health. Unfortunately, these cuts threaten the comprehensive blanket of care that so many of them have come to depend on.

HEALTHCARE COSTS Unnecessary back surgeries cost Medicare hundreds of millions of dollars annually.

Quick takeaway: A recent analysis discovered that more than 200,000 common back procedures performed on Medicare patients met the criteria for overuse and are estimated to have cost the program and taxpayers around $2 billion over a three-year period.

Digging deeper: The study underscores the cost of waste, fraud, and abuse throughout our healthcare system – costs that are ultimately shouldered by consumers, families, employers, and plan sponsors. It’s estimated that as much as $935 billion – approximately one-quarter of all healthcare spending – goes to waste each year. Additionally, up to:

• $240.5 billion is the result of pricing failures
• $165.7 billion is the result of failure of care delivery
• $101.2 billion is the result of overtreatment or low-value care

As much as $78.2 billion is also estimated to be due to failure to properly coordinate care, which results in unnecessary admissions or avoidable complications and readmissions.

What it means: Researchers point to the work already being done by health plans to ease the administrative complexity that’s largely to blame for waste, fraud, and abuse. These efforts include a focus on transitioning our healthcare model away from fee-for-service and towards value-based care, reinforcing the historically validated role that insurers play in working to better control healthcare costs.

The Health Action Network includes everyday Americans—families, workers, businesses, patients, providers, neighbors, and friends. We are working together because we support market-based solutions that offer better healthcare choices and help build a stronger economy. The Health Action Network is an Elevance Health, Inc., initiative.