Brian Fitzpatrick Grills UnitedHealth Group CEO On 'State-Regulated Health Insurance Plans'

Thank you, Miss Moore. I now yield to myself for questioning. Thank you all for being here today. Year after year, my constituents in Bucks and Montgomery counties and Pennsylvania are seeing, like so many districts across America, rising health care costs that are not isolated to just health insurance premiums, but rather all aspects of care and treatment. Small businesses have been forced to make tough decisions to address insurance costs, and our seniors, largely living on fixed incomes, have increasingly had to pay more for essential medications and treatments. And as has been mentioned by so many of my colleagues, the rapid horizontal consolidation and vertical integration of virtually all aspects of the healthcare industry have intensified the need for transparency and the adoption of policies to ensure that insurers are acting as responsible stewards of people's hard-earned money. With the three largest health insurers controlling 40% of the commercial and the Medicare Advantage market, as well as the three largest PBMs controlling 80% of the pharmacy benefit market, there are legitimate concerns by a lot of our residents back home on how patients will be adversely impacted by this unprecedented market power. Patients must continue to have access to robust provider networks and comprehensive and affordable drug formularies. As many of you know, states have been increasingly adopting policies for state-regulated health insurance plans to address the increasing costs for patients both in private and public marketplaces. In fact, over 20 states have now adopted legislation to cap monthly out-of-pocket costs for insulin in state-regulated plans. In my home state in Pennsylvania, for example, state-regulated health plans now cover comprehensive biomarker testing, leading to more targeted treatments such as precision medicine which can lower costs for cancer treatment and improve quality of life. I have my first question is regarding a bipartisan bicameral piece of legislation. Just need to know if anyone's opposed to it. It's referred to as the Patients Deserve Price Tags Act. 61% of non-Medicare patients get their insurance through their employer. Yet these employers are unable to see their own claims data for their employees. Again, it's a two-party bill in both chambers. Is anyone opposed to that legislation? Okay. Thank you. Mr. Hemsley, given UnitedHealth Group's geographic footprint and your testimony on value-based care, what trends are you seeing across states that have been effective in addressing the affordability crisis in healthcare? Can these efforts be in any way replicated at the federal level? For example, the instance I just gave you in the state of Pennsylvania?

Thank you, sir. Next, I want to discuss steps being taken to address the burdens in care created by prior authorization as well as step therapy requirements. Mr. Cordani, can you speak to Cigna's reforms surrounding your prior authorization policy and how these changes you believe will translate into better care for patients and reduce the administrative burden for providers who are already facing, as we've heard today, significant administrative burdens and challenges?

Congressman, thank you for the question. Approximately 95%, a little over 95%, of all of our customer experiences in the commercial market are not exposed to prior authorization. So around 4%, 4.5% or so. First, we committed to reduce the number of activities that were exposed to prior authorization. This past year we reduced that number by 15%. Second, advanced automation and interaction with providers. We have about 78% of all prior authorizations now are immediately or near immediately, meaning within seconds, determined and resolved. And we are committed to further reduce the total number of prior authorizations and increase that number from 78% to 90% in the foreseeable future. So reducing the number, getting to near real time, and then ensuring that a clinical professional always looks at the residual items that need to be manually reviewed. I think I speak on behalf of the vast majority of Americans that we need to get back to the basics. Get back to the basic doctor-patient relationship. All this horizontal consolidation, vertical integration has really created so many burdens, so many barriers, so many cost drivers that are not necessary. And that's got to be our goal here. And I yield back.