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News

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 > how-can-prescription-prices-drop

How can prescription prices drop while costs are going up?

2+ week, 6+ day ago   (315+ words) Summary: A record year-over-year drop in prescription drug prices, driven mainly by routine patent expirations and generic substitution, doesn’t translate into lower total costs for employer health plans. Overall costs are higher due to approval of newer, more expensive medications…...

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…...