Datapoint: FDA Approves First U.S. Herceptin Biosimilar

June 19, 2019

The FDA last week approved Amgen Inc.’s Kanjinto, a biosimilar to Roche’s Herceptin, for both of Herceptin’s oncology indications. For the treatment of breast cancer and gastric cancer, Herceptin holds preferred status for 10% of covered lives under the pharmacy benefit. It is not covered for 17% of lives.

The FDA last week approved Amgen Inc.’s Kanjinto, a biosimilar to Roche’s Herceptin, for both of Herceptin’s oncology indications. For the treatment of breast cancer and gastric cancer, Herceptin holds preferred status for 10% of covered lives under the pharmacy benefit. It is not covered for 17% of lives.

SOURCE: MMIT Analytics, as of 6/17/19

Magellan Rx Initiates Oncology Biosimilars Program

June 19, 2019

Magellan Rx Management, the PBM division of Magellan Health, Inc., on June 4 announced its launch of an oncology biosimilars program, preparing its health plan customers for the expected market entry of biosimilars for three cancer-fighting drugs — Herceptin, Rituxan and Avastin — later this year.

“Oncology is by far the largest therapeutic area for drug spend on the medical benefit, and it is even higher in Medicare,” Steve Cutts, senior vice president and general manager for Magellan Rx’s specialty drug unit, tells AIS Health. Thus, he says, the PBM will be focusing the oncology biosimilars program “on all lines of business for our clients.”

By Judy Packer-Tursman

Magellan Rx Management, the PBM division of Magellan Health, Inc., on June 4 announced its launch of an oncology biosimilars program, preparing its health plan customers for the expected market entry of biosimilars for three cancer-fighting drugs — Herceptin, Rituxan and Avastin — later this year.

“Oncology is by far the largest therapeutic area for drug spend on the medical benefit, and it is even higher in Medicare,” Steve Cutts, senior vice president and general manager for Magellan Rx’s specialty drug unit, tells AIS Health. Thus, he says, the PBM will be focusing the oncology biosimilars program “on all lines of business for our clients.”

The three oncology brand drugs together account for $9 billion in U.S. drug sales, and almost $50 million in annual drug spend per 1 million covered commercial lives, Magellan Rx says. The PBM anticipates savings of $5 million to $8 million per 1 million covered lives via its new program but sees “potential for even greater savings based on [its] past successes with biosimilars.”

Under a multi-pronged program, Magellan Rx aims to develop clinical protocols while educating and communicating with network oncologists; incorporate biosimilars into key utilization management programs, such as medical prior authorization and provider reimbursement/fee schedule management; and work continuously with its oncology advisory board.

Cutts notes that Herceptin, Rituxan and Avastin “all have FDA approved biosimilars which are due to be launched and available on the market in 2019, with some speculated to be available as soon as this month.”

Datapoint: Puerto Rico Faces Medicaid Funding Crisis

June 18, 2019

Puerto Rico’s temporary Medicaid funding following Hurricanes Irma and Maria is set to run out in September 2019, a problem that could lead to heavy enrollment cuts for the island’s 1,181,525 managed Medicaid beneficiaries. Puerto Rico is also in the midst of revamping its Medicaid delivery system to an entirely managed care-based system. Triple-S Management Corp. currently holds 29.5% of the island’s market share.

Puerto Rico’s temporary Medicaid funding following Hurricanes Irma and Maria is set to run out in September 2019, a problem that could lead to heavy enrollment cuts for the island’s 1,181,525 managed Medicaid beneficiaries. Puerto Rico is also in the midst of revamping its Medicaid delivery system to an entirely managed care-based system. Triple-S Management Corp. currently holds 29.5% of the island’s market share.

Source: AIS’s Directory of Health Plans

California Adds Mandate, Expands Health Care to Some Undocumented Immigrants

June 18, 2019

California created its own state-based individual mandate, added help for middle-income consumers purchasing coverage on the individual market, and agreed to pay for Medi-Cal coverage for undocumented young adults in a $213 billion legislative budget deal.

In the budget pact, approved June 13, California became the first state in the nation to offer subsidies for health coverage for those between 400% and 600% of the federal poverty level.

By Jane Anderson

California created its own state-based individual mandate, added help for middle-income consumers purchasing coverage on the individual market, and agreed to pay for Medi-Cal coverage for undocumented young adults in a $213 billion legislative budget deal.

In the budget pact, approved June 13, California became the first state in the nation to offer subsidies for health coverage for those between 400% and 600% of the federal poverty level.

The penalties paid by those who fail to purchase qualifying health insurance will help pay for those subsidies, according to the state. Beginning in 2020, adults will be charged $695 or 2% of their household income, whichever is more, for failing to purchase health insurance.

The legislation also expands Medi- Cal coverage to undocumented young adults ages 19 through 25 at the state’s expense, which will add approximately 90,000 young adults to the Medicaid program at a cost of around $98 million per year.

“We think for the long-term health of the exchange, having a mandate will help to get lower-risk people into the exchange,” L.A. Care Health Plan CEO John Baackes says. “It also gets the younger cohort used to participating and getting access to care whenever they need it.”

The budget deal left two other top issues for health insurers — a tax on managed care organizations and a new statewide drug purchasing plan — unresolved.

Datapoint: Managed Medicaid Penetration Rose 3% Year Over Year

June 17, 2019

Approximately 54.7 million people are currently enrolled in Medicaid managed care plans, according to the latest update to AIS’s Directory of Health Plans. Of the entire Medicaid landscape, 73.5% of lives are enrolled in managed care, a 3.3% increase from 2018.

Approximately 54.7 million people are currently enrolled in Medicaid managed care plans, according to the latest update to AIS’s Directory of Health Plans. Of the entire Medicaid landscape, 73.5% of lives are enrolled in managed care, a 3.3% increase from 2018.

Source: AIS’s Directory of Health Plans