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News

Employer Coverage
employercoverage.substack.com > p > biosimilar-medications-lead-to-large

Biosimilar medications lead to large cost savings

1+ week, 4+ day ago   (298+ words) Summary: Patients who were treated exclusively with biosimilars for three cancer medications had monthly costs $3,820 lower for insurers and about $40 lower out-of-pocket than patients exclusively on the brand-name biologic. Nonetheless, many remained on the brand name biologic medicine. Source Liu…...

Employer Coverage
employercoverage.substack.com > p > no-surprises-act-dispute-process

No Surprises Act dispute process increased medical costs by $22.4 billion over four years

1+ week, 5+ day ago   (304+ words) Summary: The No Surprises Act’s arbitration (IDR) process has generated $22.4 billion in costs since 2022, driven by rapidly rising dispute volume, provider win rates of 85%, and outsized awards well above in-network benchmarks. Costs accelerated sharply in 2025. Source: Hoadly, J and Watts,…...

Employer Coverage
employercoverage.substack.com > p > prior-authorizations-are-variable

Prior authorizations are variable across ACA marketplace plans

3+ week, 5+ day ago   (320+ words) Summary: A KFF analysis of federally mandated prior authorization data finds that ACA Marketplace insurers denied an average of 18% of standard requests in 2025 and overturned an average of 43% of appealed denials. This dataset lacks the request volumes and service-level detail…...