Molly Ferguson for STAT

Several major biotech players are racing to develop a new class of narcolepsy drugs known as orexin receptor agonists, with potentially major ramifications not only for treating sleep disorders but also for a broader class of conditions that lead people to experience fatigue during the day, like Alzheimer’s and depression.

Companies working on new narcolepsy treatments include Alkermes, Centessa Pharmaceuticals, and Takeda, my colleague Elaine Chen writes in a new story for STAT. In some cases, those companies’ executives have drawn parallels to the development of GLP-1s, in which medications studied for a narrow group end up having potential to improve the lives of a far broader population.

And while some have urged caution, other doctors see these medications as a potential turning point for narcolepsy. “It’s not that often in medicine in general that you can talk about a new therapy being truly transformative,” said Thomas Scammel, a professor of neurology at Harvard Medical School who consults for Takeda. Read more here.

ICE refusing medical care for disabled detainees, advocacy group says

People with disabilities are being “treated like dogs” at Immigration and Customs Enforcement processing centers, according to a recent report by Disability Rights California. The quote came from a detainee, who shouted the phrase in Spanish at a DRC official who was conducting a monitoring visit at the Adelanto ICE Processing Center north of Los Angeles. When DRC investigated the facility in 2019, it found grim conditions for people with disabilities.

The recent report said that one person with diabetes needed to take his medication twice per day — but only received it twice over the 10 days he had been detained. Another person sought help for panic attacks he was having from past traumatic events, but had not been evaluated despite residing in the detention center for over three weeks. Other detainees reported insufficient access to critical medications. ICE did not respond to STAT’s request for comment on the report.

This is not the only recent claim that ICE has struggled to meet the needs of disabled detainees. In the spring, ICE officials reportedly refused crucial asthma medications to Rümeysa Öztürk, a Tufts University Ph.D. student. — O. Rose Broderick

telehealth

Medicare advisors release fresh telehealth data

According to newly published data from a 2024 survey by the Medicare Payment Advisory Commission:

• One-third of Medicare enrollees reported using a telehealth service in the past year, compared to 36% of privately insured people aged 50 to 64. For context, according to 2023 claims data from Medicare, 25% of enrollees used a telehealth service. There are a number of possible reasons for the gap between those numbers.
• 44% of Medicare enrollees are interested in having a telehealth option, compared to 61% of privately insured people in the 50 to 64 age bracket.
• 90% or more of telehealth users reported being satisfied with their visits.
• “Telehealth visits were more commonly used by Medicare beneficiaries who lived in urban areas, had household incomes of at least $50,000, and were under the age of 75.”

from Endpoints:

Health insurers’ latest problem

Remember when Medicare Advantage was the thorn in every health insurer’s side? Things have changed.
Now insurers are dropping their profit outlooks for the year, in large part as they struggle to control a perfect storm of problems in the ACA marketplace. Oscar Health, which primarily sells marketplace plans, on Tuesday took a hatchet to its 2025 guidance and said it now expects a loss from operations of $200 million to $300 million. In February, it had projected earnings from operations of at least $225 million.
It follows Elevance Health and Centene, which both lowered or scrapped their outlooks this month, pointing to higher medical costs in that business. (Molina Healthcare and UnitedHealth Group also reduced or pulled guidance on challenges with government programs.)
So far, it looks like the problems aren’t insurer-specific, but systemic. Insurers reaped the gains from ballooning ACA enrollment, driven by Biden-era enhanced premium subsidies. But the membership of the marketplace has since grown sicker and more expensive, Oscar, Elevance and Centene warned.
“The ACA marketplace is in the midst of a broad recalibration that is exerting near-term pressure on managed care performance across the industry,” Elevance CFO Mark Kaye said during the company’s earnings call Thursday.
As states crack down on Medicaid eligibility, those members who really need care are switching to the ACA marketplace and driving up costs, Kaye noted. Meanwhile, healthier ACA members needed to balance out the sicker ones are leaving. Patients are also using more care in general, and the company called out healthcare providers using AI to code diagnoses more aggressively.
Health insurance is all about predicting risk, and it’s been tough to do that in the wake of Covid-19 as patients sought care in droves, and amid so many shifting government policies. Conditions are sure to worsen — and premiums will certainly jump — as millions of people lose coverage from Medicaid cuts and the likely expiration of enhanced ACA subsidies. Though Elevance tried painting these as short-term problems, it’s hard to see insurers on steady footing any time soon.
A final thought: I can’t help thinking about innovations like individual coverage HRAs (or ICHRAs) that work only when there’s a strong individual insurance market. If the ACA marketplace crumbles, what will become of them? Let me know what you think!
– Shelby