People on the Move

February 26, 2021

Flex Benefits Take Off Amid Pandemic, New Analysis Shows

February 26, 2021

Medicare Advantage organizations are continuing to embrace flexible benefits, with the number of plans offering Special Supplemental Benefits for the Chronically Ill (SSBCI) exploding from 245 in 2020 to 831 in 2021, according to a Jan. 27 analysis of CMS data from Faegre Drinker. While the pandemic is just one factor driving the increase, the prevalence of certain benefits points to more seniors seeking help from home. Of the new benefits approved for 2021, virtual companion visits are offered by 62 plans. There was also a sharp uptick in the number of plans offering pre-made meals (up 228% from 2020) and food and produce delivery (up 242%). While diabetes and congestive heart failure remain the most commonly targeted conditions, mental health disorders took the No. 3 spot in 2021, with 230 MA plans offering benefits related to anxiety, depression and substance use disorder, compared to zero plans in 2020. Faegre’s researchers tell AIS Health this is likely related to the surge in demand for behavioral health services amid the pandemic.

by Carina Belles

Medicare Advantage organizations are continuing to embrace flexible benefits, with the number of plans offering Special Supplemental Benefits for the Chronically Ill (SSBCI) exploding from 245 in 2020 to 831 in 2021, according to a Jan. 27 analysis of CMS data from Faegre Drinker. While the pandemic is just one factor driving the increase, the prevalence of certain benefits points to more seniors seeking help from home. Of the new benefits approved for 2021, virtual companion visits are offered by 62 plans. There was also a sharp uptick in the number of plans offering pre-made meals (up 228% from 2020) and food and produce delivery (up 242%). While diabetes and congestive heart failure remain the most commonly targeted conditions, mental health disorders took the No. 3 spot in 2021, with 230 MA plans offering benefits related to anxiety, depression and substance use disorder, compared to zero plans in 2020. Faegre’s researchers tell AIS Health this is likely related to the surge in demand for behavioral health services amid the pandemic.

NOTES: CAD=Coronary Artery Disease; CHF=Congestive Heart Failure; COPD=Chronic Obstructive Pulmonary Disease; SUD=Substance Use Disorder.

SOURCE: An Early Look at 2021 Medicare Advantage Benefits: Part II, Faegre Drinker analysis of CMS data, Jan. 27, 2021. Visit https://bit.ly/3tQD9Kw.

Datapoint: Court Ruling Clears Path for North Carolina Medicaid Transformation

February 25, 2021

A North Carolina superior court judge last week upheld an earlier ruling that dismissed requests to halt the state’s Medicaid managed care transformation, which has been in limbo since contracts were awarded in Feb. 2019. A statewide enrollment period will begin March 15 and run through mid-May. About 1.6 million of the state’s 2,418,324 Medicaid beneficiaries will be enrolled in plan offerings from AmeriHealth Caritas, Blue Cross and Blue Shield of North Carolina, Centene Corp. and UnitedHealthcare. The managed care plans will officially launch July 1 of this year.

A North Carolina superior court judge last week upheld an earlier ruling that dismissed requests to halt the state’s Medicaid managed care transformation, which has been in limbo since contracts were awarded in Feb. 2019. A statewide enrollment period will begin March 15 and run through mid-May. About 1.6 million of the state’s 2,418,324 Medicaid beneficiaries will be enrolled in plan offerings from AmeriHealth Caritas, Blue Cross and Blue Shield of North Carolina, Centene Corp. and UnitedHealthcare. The managed care plans will officially launch July 1 of this year.

Source: AIS’s Directory of Health Plans

White House to Roll Out Johnson & Johnson Vaccine Doses Next Week, Pending Authorization

February 25, 2021

The United States expects to roll out three to four million doses of Johnson & Johnson’s COVID-19 vaccine next week, pending authorization from the Food and Drug Administration, White House COVID-19 response coordinator Jeff Zients said on Wednesday.

A Johnson & Johnson executive on Tuesday said the company expected to ship nearly 4 million doses of the vaccine once it gained authorization.

The United States expects to roll out three to four million doses of Johnson & Johnson’s COVID-19 vaccine next week, pending authorization from the Food and Drug Administration, White House COVID-19 response coordinator Jeff Zients said on Wednesday.

A Johnson & Johnson executive on Tuesday said the company expected to ship nearly 4 million doses of the vaccine once it gained authorization.

The additional vaccine will help President Joe Biden’s administration in its goal of ramping up vaccination across the country as it seeks to control the pandemic that has cost more than 500,000 lives in the United States and pummeled the economy….

Read the full Reuters article

Four Takeaways From Xavier Becerra’s Confirmation Hearings

February 25, 2021

Health and Human Services Secretary-designate Xavier Becerra appears to be on a smooth path to Senate confirmation. But two days of generally collegial hearings in the Senate HELP and Finance committees exposed fault lines that could shape President Joe Biden’s post-pandemic agenda and will define health policy debates leading into the midterm elections.

Here are four key takeaways:

Health and Human Services Secretary-designate Xavier Becerra appears to be on a smooth path to Senate confirmation. But two days of generally collegial hearings in the Senate HELP and Finance committees exposed fault lines that could shape President Joe Biden’s post-pandemic agenda and will define health policy debates leading into the midterm elections.

Here are four key takeaways:

The fight is shifting from who gets covered to the cost

Republican and Democratic senators grilled Becerra on Tuesday and Wednesday on how the Biden administration will work to bring down the cost of insurance coverage, prescription drugs, and medical tests and procedures. Though he offered few specifics, the questioning signaled a major shift from past battles over how to get more people insured….

Read the full Politico article

Analysts Downplay Stock Selloff Following CVS 4Q Earnings Report

February 25, 2021

Although CVS Health Corp.’s stock price dropped about 5% after the company reported its fourth-quarter and full-year 2020 financial results on Feb. 16, equities analysts seemed to be unshaken in their view that the firm — which owns health insurer Aetna — has strong fundamentals.

For the fourth quarter of 2020, CVS’s net income of $975 million was down 44% compared with the prior-year period, a result the company partially attributed to lower operating income driven by the impact of the COVID-19 pandemic on its Health Care Benefits and Retail/Long-Term Care segments. For the full year 2020, CVS’s operating income and net income increased relative to 2019.

NOTE: The abstract below is a shortened version of the Health Plan Weekly article “Analysts Shrug at Stock Selloff Following CVS Earnings Report.”

By Leslie Small

Although CVS Health Corp.’s stock price dropped about 5% after the company reported its fourth-quarter and full-year 2020 financial results on Feb. 16, equities analysts seemed to be unshaken in their view that the firm — which owns health insurer Aetna — has strong fundamentals.

For the fourth quarter of 2020, CVS’s net income of $975 million was down 44% compared with the prior-year period, a result the company partially attributed to lower operating income driven by the impact of the COVID-19 pandemic on its Health Care Benefits and Retail/Long-Term Care segments. For the full year 2020, CVS’s operating income and net income increased relative to 2019.

Total revenues in the fourth quarter and full-year 2020 increased 4% and 4.6%, respectively, compared with the prior year, according to CVS’s earnings release. The company’s fourth-quarter adjusted earnings per share of $1.30 beat the Wall Street consensus of $1.24.

In a Feb. 17 note, Citi analyst Ralph Giacobbe said his firm views CVS’s results “as generally balanced, with better performance within PBM and health benefits, and in line for its retail segment.” Nevertheless, he acknowledged that “we received a number of calls/emails on the heels of the CVS 4Q20 print/guidance and the subsequent sell-off in shares.”

In their own Feb. 17 note, Evercore ISI analysts weighed in that “CVS’s stock price is down ~5% as we write, which seems overdone to us.” The company’s 2021 guidance “was in-line with prior commentary, which makes sense given that there is little incentive to be aggressive at this point in the year and with Karen [Lynch] just taking over the reins,” they added. Lynch, formerly president of Aetna, replaced the retiring Larry Merlo as CVS CEO on Feb. 1.

Giacobbe observed that CVS’s “commentary around utilization assumptions for the year also raised questions/concerns, as management noted that it was not projecting high levels of pent-up demand given system capacity constraints.”

Lynch said during earnings call that in the fourth quarter the company saw utilization of total health care services “return to more near-normal seasonal levels as higher COVID-related costs were partially offset by somewhat lower levels of traditional services.”

CVS said total medical membership in its Health Care Benefits segment rose by about 140,000 from the third to fourth quarters, reaching 23.4 million. That largely reflected enrollment increases in its Medicaid and Medicare plans, but those gains were partially offset by a 35,000 decline in commercial enrollment.

Datapoint: Regeneron’s Evkeeza Scores First-in-Class Approval for Ultra-Rare Heart Disease

February 24, 2021

The FDA on Feb. 11 approved Regeneron Pharmaceuticals, Inc.’s Evkeeza as an adjunct treatment to other low-density lipoprotein lowering therapies in patients 12 and older with homozygous familial hypercholesterolemia (HoFH), an ultra-rare genetic form of high cholesterol. This is Regeneron’s first cholesterol win since its 2015 launch of Praluent. Praluent (a joint venture with Sanofi) is not approved to treat HoFH, unlike PCSK9 rival Repatha, an Amgen stalwart. For the treatment of HoFH, Repatha holds preferred formulary placement for 2% of all covered lives, growing to 51% with utilization management restrictions applied.

The FDA on Feb. 11 approved Regeneron Pharmaceuticals, Inc.’s Evkeeza as an adjunct treatment to other low-density lipoprotein lowering therapies in patients 12 and older with homozygous familial hypercholesterolemia (HoFH), an ultra-rare genetic form of high cholesterol. This is Regeneron’s first cholesterol win since its 2015 launch of Praluent. Praluent (a joint venture with Sanofi) is not approved to treat HoFH, unlike PCSK9 rival Repatha, an Amgen stalwart. For the treatment of HoFH, Repatha holds preferred formulary placement for 2% of all covered lives, growing to 51% with utilization management restrictions applied.

SOURCE: MMIT Analytics, as of 2/22/21

To Make More Covid-19 Vaccines, Rival Drugmakers Team Up

February 24, 2021

Some of the world’s biggest drugmakers are joining forces with rivals to help produce Covid-19 vaccines, forging unusual alliances that promise to substantially increase supplies by this summer.

Normally big pharmaceutical companies compete to sell cancer, arthritis and other drugs. The desperate need for Covid-19 vaccines, however, is turning fierce industry competitors into fast pandemic friends.

Sanofi SA recently agreed to help make a vaccine from Pfizer Inc. and its partner BioNTech SE after Sanofi’s experimental Covid-19 shot suffered a five-month setback, freeing up a production line in Frankfurt….

Some of the world’s biggest drugmakers are joining forces with rivals to help produce Covid-19 vaccines, forging unusual alliances that promise to substantially increase supplies by this summer.

Normally big pharmaceutical companies compete to sell cancer, arthritis and other drugs. The desperate need for Covid-19 vaccines, however, is turning fierce industry competitors into fast pandemic friends.

Sanofi SA recently agreed to help make a vaccine from Pfizer Inc. and its partner BioNTech SE after Sanofi’s experimental Covid-19 shot suffered a five-month setback, freeing up a production line in Frankfurt….

Read the full The Wall Street Journal article

Biden Moves to End Medicaid Work Requirements, States Might Not Pursue Legal Remedies

February 24, 2021

In recent weeks, the Biden administration has begun the process of rescinding Trump-era waiver programs authorizing Medicaid work requirements. Experts say that the new administration has a strong legal position in doing so, and that the moves are part of a larger strategy to bolster Medicaid.

On Feb. 12, CMS sent letters to states that received Section 1115 waivers under the Trump administration that allowed them to require certain Medicaid beneficiaries to prove they are employed, looking for work or volunteering. The letters noted that “CMS may withdraw waivers or expenditure authorities if it ‘find[s] that [a] demonstration project is not likely to achieve the statutory purposes,’” citing federal Medicaid law.

NOTE: The abstract below is a shortened version of the Health Plan Weekly article “States Might Not Fight Medicaid Work Requirement Rollback.”

By Peter Johnson

In recent weeks, the Biden administration has begun the process of rescinding Trump-era waiver programs authorizing Medicaid work requirements. Experts say that the new administration has a strong legal position in doing so, and that the moves are part of a larger strategy to bolster Medicaid.

On Feb. 12, CMS sent letters to states that received Section 1115 waivers under the Trump administration that allowed them to require certain Medicaid beneficiaries to prove they are employed, looking for work or volunteering. The letters noted that “CMS may withdraw waivers or expenditure authorities if it ‘find[s] that [a] demonstration project is not likely to achieve the statutory purposes,’” citing federal Medicaid law.

According to the Kaiser Family Foundation, eight states have had work requirements approved by the agency, seven had applications pending with CMS and four more have their work requirement policies under legal review. Also, the Supreme Court elected in December to review decisions by an appeals court that blocked Arkansas’ and New Hampshire’s work requirement waivers.

David Kaufman, a partner at Laurus Law Group LLC, says that federal judges have so far taken the same dim view of work requirements’ legality as Biden’s CMS.

“The courts didn’t feel like [CMS under Trump] considered that the primary purpose of Medicaid is to provide health care coverage,” Kaufman says. “So how is a program that demonstrably decreases health care coverage consistent with the program’s purpose?”

Still, “at least four justices feel that [the appeals court’s decision] is something that they want to review, and now we have a more conservative Supreme Court,” Kaufman observes.

Dan Mendelson, founder of Avalere Health, says that it’s an open question whether states will pursue further legal remedies.

“When you read the CMS letters to these states, it’s clear that CMS believes that it holds all the cards. These are very assertive letters,” Mendelson says. “I think in all likelihood we will see most states pulling back from these policies….The question, I think, is if there could be one or two states that decide to go to the mat.”

Mendelson adds the Biden administration is making a winning political play by bolstering Medicaid. The COVID-19 relief package currently under consideration in the House of Representatives includes an enhanced Medicaid match rate for states that take up Medicaid expansion. He points to a wave of ballot initiatives that have expanded Medicaid in Republican-leaning states.

Datapoint: Commonwealth Care Alliance to Expand Mass. Duals Demo

February 23, 2021

Boston-based community health org Commonwealth Care Alliance last week said it is expanding its One Care plan, a joint demonstration project with CMS that serves Medicare-Medicaid dual eligibles, into Berkshire County, Massachusetts. CCA currently serves 39,446 duals in Massachusetts, with 70.8% enrolled in One Care.

Boston-based community health org Commonwealth Care Alliance last week said it is expanding its One Care plan, a joint demonstration project with CMS that serves Medicare-Medicaid dual eligibles, into Berkshire County, Massachusetts. CCA currently serves 39,446 duals in Massachusetts, with 70.8% enrolled in One Care.

Source: AIS’s Directory of Health Plans