The AMA News reports that “Researchers say there’s early evidence that patients actively involved in care can mean more spending — and, perhaps, greater health disparities. At least in the hospital setting, a more engaged patient is also a more expensive patient, say researchers from the University of Chicago.” Apparently, informed doctors can bring down spending but patients say “Give me more, I’ve got insurance.”

The Mercer consulting firm released a study finding that employers are now recognizing that the Affordable Care Act will be increasing their employee health plan expenses more than they first expected. “In 2011, 25% of survey respondents expected the law would have little or no impact on cost (adding less than 1%). In 2013, only 9% expect to get off so easily. And now 19% of respondents expect cost to rise significantly (by 5% or more), compared to just 15% in 2011.”  Of course, until late last year, most employers were unaware of the transitional reinsurnance fee of $63 per head that the ACA will impose on all health plans, including FEHB plans, next year.

Consumer groups are feeling their oats understandably. Kaiser Health News reports that women’s advocacy groups have charged large self-insured employers (not FEHB plans) with sex discrimination allegedly prohibited by ACA Section 1557 by refusing maternity benefits to employees’ daughters. That provision reported prohibits discrimination in any health program or activity that receives federal financial assistance, such as research grants. All of the employers are educational or research institutions. The complaint was submitted to HHS Office for Civil Rights. The employers are content that the law continues to allow them the discretion to exclude this coverage. A California based consumer group is suing major health plans for requiring members to use mail order pharmacies. The group reported reached a favorable settlement with a major insurer on behalf of a group of members with HIV/AIDS.

Cost curve up as usual.

In business news, Catamaran, a PBM that is not Express Scripts or CVS Caremark, announced a 10 year strategic deal with Cigna.  Catamaran had been the PBM for Healthspring, a business that Cigna recently acquired. Catamaran also released its downloadable drug trend report.