People on the Move

April 16, 2021

Public Holds Favorable Views of Big Pharma, But Still Wants Drug Pricing Reforms

April 16, 2021

The pharmaceutical industry is gaining popularity with the American public amid the pandemic, according to a recent Data for Progress poll of 1,225 likely voters in late March. Pfizer Inc., Moderna, Inc. and Johnson & Johnson — three pharmaceutical companies that delivered COVID-19 vaccines in less than a year — saw particularly high popularity ratings. Despite the favorable views, the majority of Americans across party lines are supportive of drug pricing reforms, with 73% saying they disapprove of how pharma companies are handling the rising cost of prescription drugs.

by Jinghong Chen

The pharmaceutical industry is gaining popularity with the American public amid the pandemic, according to a recent Data for Progress poll of 1,225 likely voters in late March. Pfizer Inc., Moderna, Inc. and Johnson & Johnson — three pharmaceutical companies that delivered COVID-19 vaccines in less than a year — saw particularly high popularity ratings. Despite the favorable views, the majority of Americans across party lines are supportive of drug pricing reforms, with 73% saying they disapprove of how pharma companies are handling the rising cost of prescription drugs.

SOURCE: Data for Progress. Visit https://bit.ly/2PYZk1I.

Datapoint: Ohio Announces 2022 Medicaid Contract Awards

April 15, 2021

The state of Ohio on April 9 unveiled contract awards for its revamped Medicaid managed care program, with enrollment set to begin in January 2022. Four payers, CareSource, Centene Corp. Molina Healthcare and UnitedHealthcare are incumbents, while Humana Inc. and Anthem, Inc. will be new entrants. ProMedica’s Paramount Advantage, which currently enrolls 238,129 Ohio Medicaid members, was not selected to renew its contract. Ohio’s Medicaid program currently serves 2,749,113 lives, with 91.1% enrolled in a managed care plan.

The state of Ohio on April 9 unveiled contract awards for its revamped Medicaid managed care program, with enrollment set to begin in January 2022. Four payers, CareSource, Centene Corp. Molina Healthcare and UnitedHealthcare are incumbents, while Humana Inc. and Anthem, Inc. will be new entrants. ProMedica’s Paramount Advantage, which currently enrolls 238,129 Ohio Medicaid members, was not selected to renew its contract. Ohio’s Medicaid program currently serves 2,749,113 lives, with 91.1% enrolled in a managed care plan.

Source: AIS’s Directory of Health Plans

Four Things to Know About the J&J Covid Vaccine Pause

April 15, 2021

Four months into the largest U.S. vaccine rollout in decades, it’s become clear that the messaging surrounding covid-19 vaccination efforts is as important as the science behind them.

That was true when the first covid vaccines were introduced in December at hospitals and nursing homes and even more so after the federal government on Tuesday paused the Johnson & Johnson vaccine after reports of extremely rare but very serious — in one case, fatal — side effects emerged.

Four months into the largest U.S. vaccine rollout in decades, it’s become clear that the messaging surrounding covid-19 vaccination efforts is as important as the science behind them.

That was true when the first covid vaccines were introduced in December at hospitals and nursing homes and even more so after the federal government on Tuesday paused the Johnson & Johnson vaccine after reports of extremely rare but very serious — in one case, fatal — side effects emerged.

Most health experts largely applauded the government for its decision, saying it showed regulators making vaccine safety their top priority. They said regulators need to strike a balance between addressing small but serious risks while encouraging millions to get inoculated to quickly end the pandemic.

“The pause is a good decision and shows the public health system is working,” said Noel Brewer, a professor in the health behavior department at the University of North Carolina-Chapel Hill….

Read the full Kaiser Health News article

CDC Vaccine Advisers Seek More Data on Rare Blood Clots Before Deciding Whether to Resume Johnson & Johnson Shots

April 15, 2021

A federal vaccine advisory committee said Wednesday it wanted more data before deciding whether to resume use of Johnson & Johnson’s coronavirus vaccine, leaving in place a pause that federal officials had recommended because of a rare and severe type of blood clot identified so far among six of the 7.5 million people who received the shot.

The move means the single-shot Johnson & Johnson product will remain on the shelf for at least a week.

A federal vaccine advisory committee said Wednesday it wanted more data before deciding whether to resume use of Johnson & Johnson’s coronavirus vaccine, leaving in place a pause that federal officials had recommended because of a rare and severe type of blood clot identified so far among six of the 7.5 million people who received the shot.

The move means the single-shot Johnson & Johnson product will remain on the shelf for at least a week.

At a hastily arranged emergency meeting a day after federal officials recommended a pause in use of the vaccine, advisers to the Centers for Disease Control and Prevention agreed to reconvene within 10 days, acknowledging the urgency of making a decision about a vaccine that is a key part of the strategy to end the pandemic in the United States and globally….

Read the full The Washington Post article

COVID Relief Bill May Give States Incentives to Expand Medicaid

April 15, 2021

With the passage of the American Rescue Plan (ARP), states that haven’t expanded Medicaid have an extra reason to do so: the COVID-19 relief bill offers financial incentives to states that increase Medicaid eligibility under the Affordable Care Act (ACA). Some states where Medicaid expansion has historically been a nonstarter to conservative elected officials are reconsidering their status.

The ARP gives states that expand Medicaid a 5 percentage-point increase in their Federal Medical Assistance Percentage (FMAP) for the first two years of expansion. That’s in addition to the 6.2 percentage-point FMAP increase that all states are getting for the duration of COVID-19, and the 90% federal funding match rate that Medicaid expansion states receive under the ACA.

NOTE: The abstract below is a shortened version of the Health Plan Weekly article “With New Subsidies, Holdout States May Expand Medicaid.”

By Peter Johnson

With the passage of the American Rescue Plan (ARP), states that haven’t expanded Medicaid have an extra reason to do so: the COVID-19 relief bill offers financial incentives to states that increase Medicaid eligibility under the Affordable Care Act (ACA). Some states where Medicaid expansion has historically been a nonstarter to conservative elected officials are reconsidering their status.

The ARP gives states that expand Medicaid a 5 percentage-point increase in their Federal Medical Assistance Percentage (FMAP) for the first two years of expansion. That’s in addition to the 6.2 percentage-point FMAP increase that all states are getting for the duration of COVID-19, and the 90% federal funding match rate that Medicaid expansion states receive under the ACA.

Two states that recently expanded Medicaid by ballot initiative, Missouri and Oklahoma, are also eligible for the enhanced funding match as long as they implement their expansions by July.

Meanwhile, Wyoming’s Republican-controlled House of Representatives passed an expansion bill in March, though it died in the Senate. Robin Rudowitz, a vice president at the Kaiser Family Foundation, says that ARP changed the political equation in Wyoming.

“The Medicaid expansion bill clearly was tied to the incentive and the American Rescue Plan,” she says. She adds that Mississippi, South Dakota, and the Carolinas all are closer to expansion than they were before the pandemic relief law passed.

“In Georgia, Wyoming, Texas, Alabama, Florida and Tennessee, there are legislators on the Democratic side that are pushing for this,” says Jerry Vitti, founder and CEO of Healthcare Financial, Inc. “However, there is still a lot of resistance among Republicans.”

That’s especially true in Missouri. Voters there approved an August 2020 initiative that amended the state constitution to expand Medicaid, but the Republican-controlled legislature has dug in its heels during its current session, despite Republican Gov. Mike Parson’s pledge to implement expansion. According to Kaiser Health News, Republican state Rep. Justin Hill said during a recent floor debate that “even though my constituents voted for this lie, I am going to protect them from this lie.”

“Trying to go in and overturn the will of the plurality of voters is a very, very risky strategy,” says Dan Mendelson, founder of Avalere Health. “I don’t think it’s going to work in the longer term, because if people vote for something and then they see their legislators complain — it’s very cynical.”

Biden Administration Moves To Undo Trump Abortion Rules For Title X

April 14, 2021

The Biden administration is moving to reverse a Trump-era family planning policy that critics describe as a domestic “gag rule” for reproductive healthcare providers.

The proposal published on Wednesday would largely return the federal Title X family planning program to its status before Trump took office. The current rules, implemented in March 2019 under Trump, forbid any provider who provides or refers patients for abortions from receiving federal funding through Title X to cover services such as contraception and STD screenings for low-income people.

The Biden administration is moving to reverse a Trump-era family planning policy that critics describe as a domestic “gag rule” for reproductive healthcare providers.

The proposal published on Wednesday would largely return the federal Title X family planning program to its status before Trump took office. The current rules, implemented in March 2019 under Trump, forbid any provider who provides or refers patients for abortions from receiving federal funding through Title X to cover services such as contraception and STD screenings for low-income people.

“As a result of the dramatic decline in Title X services provided, the 2019 Final Rule undermined the mission of the Title X program by helping fewer individuals in planning and spacing births, providing fewer preventive health services, and delivering fewer screenings” for sexually transmitted infections, said the proposed rule published by the U.S. Department of Health and Human Services….

Read the full NPR article

Datapoint: Gilead Shores Up Breast Cancer Indication for Trodelvy

April 14, 2021

The FDA last week granted Gilead Sciences’ Trodelvy full approval for the treatment of triple-negative breast cancer (TNBC) — clearing the drug for use in TNBC patients who have received two or more prior treatments, with at least one treatment administered in a metastatic setting. Previously, the drug was approved for use in patients who had received at least two prior treatments in a metastatic setting. Trodelvy, which Gilead picked up via its $21 billion acquisition of Immunomedics, Inc. last October, currently holds preferred formulary placement for just 3% of all covered lives. It is not covered for 23% of all insured lives.

The FDA last week granted Gilead Sciences’ Trodelvy full approval for the treatment of triple-negative breast cancer (TNBC) — clearing the drug for use in TNBC patients who have received two or more prior treatments, with at least one treatment administered in a metastatic setting. Previously, the drug was approved for use in patients who had received at least two prior treatments in a metastatic setting. Trodelvy, which Gilead picked up via its $21 billion acquisition of Immunomedics, Inc. last October, currently holds preferred formulary placement for just 3% of all covered lives. It is not covered for 23% of all insured lives.

SOURCE: MMIT Analytics, as of 4/9/21

Oncologists Are Likely to Prescribe Fotivda for Advanced RCC

April 14, 2021

The renal cell carcinoma (RCC) therapeutic class boasts multiple agents, but a recent entrant is offering a new tool for certain patients. A Zitter Insights survey shows that the majority of oncologist respondents are likely to prescribe Aveo Oncology’s Fotivda (tivozanib) for advanced RCC.

On March 10, the FDA approved Fotivda for the treatment of adults with relapsed or refractory advanced RCC who have received at least two prior systemic therapies. It is the first FDA-approved therapy for this use.

NOTE: The abstract below is a shortened version of the RADAR on Specialty Pharmacy article “Oncologists Say They Expect To Prescribe Fotivda for RCC.”

By Angela Maas

The renal cell carcinoma (RCC) therapeutic class boasts multiple agents, but a recent entrant is offering a new tool for certain patients. A Zitter Insights survey shows that the majority of oncologist respondents are likely to prescribe Aveo Oncology’s Fotivda (tivozanib) for advanced RCC.

On March 10, the FDA approved Fotivda for the treatment of adults with relapsed or refractory advanced RCC who have received at least two prior systemic therapies. It is the first FDA-approved therapy for this use.

For the Managed Care Oncology Index: Q4 2020, from Dec. 2, 2020, to Jan. 5, 2021, Zitter Insights polled 40 commercial payers with 132.0 million covered lives. Payers with 84% of lives expected they would manage the drug to label, while those with 10% of lives anticipated covering it more restrictively than its label. Respondents with 6% of lives expected that they would not require prior authorization for Fotivda. None of the payers anticipated not covering the drug.

The drug’s approval was based on a handful of clinical trials, including TIVO-3, a Phase III study pitting it against Bayer’s Nexavar (sorafenib). Payers covering 40% of lives said they are likely to use Fotivda to negotiate greater discounts for Nexavar, but those with 42% of lives said they are unlikely to take that action. Those covering 78% of lives do not expect to prefer Fotivda over Nexavar in advanced RCC and do not anticipate incentivizing oncologists to prescribe Fotivda over Nexavar.

Zitter Insights also surveyed 100 oncologists during the same time frame. Almost 70% said they were likely to prescribe Fotivda for advanced RCC, as well as prescribe it over Nexavar. Respondents were fairly evenly divided on whether they would refrain from prescribing Nexavar.

In the TIVO-3 trial, points out Mesfin Tegenu, CEO of RxParadigm, “Fotivda was able to show improved progression-free survival compared to sorafenib. However, Fotivda fell short in showing overall survival relative to sorafenib. The key takeaway for Fotivda will be its safety profile relative to current therapies for RCC. Therefore, Fotivda may be an option for a subset of patients who have failed previous therapies and require a more tolerable and safe option.”

Datapoint: Biden Administration Pulls Work Requirements in Michigan, Wisconsin

April 13, 2021

The Biden administration last week nixed Medicaid work requirement approvals in two more states — Michigan and Wisconsin. The news comes just three weeks after Biden’s CMS pulled the controversial Medicaid reform in Arkansas and New Hampshire. Implementation of Wisconsin’s work requirement was already on hold as a result of the COVID-19 pandemic, while Michigan’s were blocked by a federal judge two months after they went into effect in January 2020. Wisconsin currently enrolls 1,108,482 Medicaid beneficiaries, to Michigan’s 2,663,882.

The Biden administration last week nixed Medicaid work requirement approvals in two more states — Michigan and Wisconsin. The news comes just three weeks after Biden’s CMS pulled the controversial Medicaid reform in Arkansas and New Hampshire. Implementation of Wisconsin’s work requirement was already on hold as a result of the COVID-19 pandemic, while Michigan’s were blocked by a federal judge two months after they went into effect in January 2020. Wisconsin currently enrolls 1,108,482 Medicaid beneficiaries, to Michigan’s 2,663,882.

Source: AIS’s Directory of Health Plans