People on the Move

August 16, 2019

Average Medicare Part D Base Beneficiary Premium Declines for Third Straight Year

August 16, 2019

CMS said on July 30 that the Part D base beneficiary premium for 2020 will be $32.74, down from $33.19 in 2019, and the de minimis amount is $2. The Part D national average monthly bid amount also dropped slightly, from $51.28 in 2019 to $47.59 in 2020. Regional low-income premium subsidy amounts fluctuated over the past six years, but all states are projected to see a decrease in 2020.

by Jinghong Chen

CMS said on July 30 that the Part D base beneficiary premium for 2020 will be $32.74, down from $33.19 in 2019, and the de minimis amount is $2. The Part D national average monthly bid amount also dropped slightly, from $51.28 in 2019 to $47.59 in 2020. Regional low-income premium subsidy amounts fluctuated over the past six years, but all states are projected to see a decrease in 2020.


SOURCE: CMS. Visit https://go.cms.gov/2arFZfX. Infographic compiled by AIS Health.

Datapoint: Centene Expanding 2020 Exchange Offerings in 10 States

August 15, 2019

Centene Corp. this week said it will expand its 2020 exchange offerings in ten of its state markets; Arizona, Florida, Georgia, Kansas, North Carolina, Ohio, South Carolina, Tennessee, Texas and Washington. Centene is currently the Affordable Care Act exchange market leader, with 1,968,416 enrollees nationwide. Its three largest state markets are Florida (520,104 lives), New York (264,853 lives) and Georgia (205,967 lives).

Centene Corp. this week said it will expand its 2020 exchange offerings in ten of its state markets; Arizona, Florida, Georgia, Kansas, North Carolina, Ohio, South Carolina, Tennessee, Texas and Washington. Centene is currently the Affordable Care Act exchange market leader, with 1,968,416 enrollees nationwide. Its three largest state markets are Florida (520,104 lives), New York (264,853 lives) and Georgia (205,967 lives).

Source: AIS’s Directory of Health Plans

More Than 1,000 RM/AT Products Are in Pipeline

August 15, 2019

This past quarter saw two new gene therapies: Novartis AG subsidiary AveXis, Inc.’s Zolgensma (onasemnogene abeparvovec-xioi) received FDA approval May 24 for the treatment of spinal muscular atrophy, and bluebird bio’s Zynteglo (autologous CD34+ cells encoding βA-T87Q-globin gene) received conditional marketing authorization from the European Commission for transfusion-dependent beta thalassemia.

While only a handful of therapies in the broader regenerative medicine/advanced therapy (RM/AT) space are available globally, a new report shows that is likely to change, as there are more than 1,000 products in the pipeline.

By Angela Maas

This past quarter saw two new gene therapies: Novartis AG subsidiary AveXis, Inc.’s Zolgensma (onasemnogene abeparvovec-xioi) received FDA approval May 24 for the treatment of spinal muscular atrophy, and bluebird bio’s Zynteglo (autologous CD34+ cells encoding βA-T87Q-globin gene) received conditional marketing authorization from the European Commission for transfusion-dependent beta thalassemia.

While only a handful of therapies in the broader regenerative medicine/advanced therapy (RM/AT) space are available globally, a new report shows that is likely to change, as there are more than 1,000 products in the pipeline.

The Alliance for Regenerative Medicine published the report, titled Quarterly Global Regenerative Medicine Sector Report: Q2 2019, on Aug. 1. It shows there are 1,069 clinical trials using specific RM/AT technologies, which include gene therapy, gene-modified cell therapy, cell therapy and tissue engineering. Ninety-four of those products are in Phase III trials.

While Zolgensma’s $2.125 million price for a one-time infusion makes it the costliest drug on the planet, many other newer RM/AT products are certainly not cheap. Though many manufacturers are offering various reimbursement schemes, including rebates if a therapy doesn’t work, other outcomes-based deals and multiyear pay-over-time payment options, experts note that many barriers exist in the execution of these strategies.

“In principle, spreading the cost over a five-year period and putting the cost installments at risk based upon efficacy is a good approach,” says Winston Wong, Pharm.D., president of W-Squared Group, about Zolgensma. “However, the devil is in the details. Do we have the systems in place that have the capability to administer a five-year contract?”

According to Wong, “From the manufacturer perspective, a value-based contract implies that no payment would be made if the patient relapses or passes on. Systems are not in place to have the ability to track the patient once therapy is administered.”

As States Strive to Stabilize Insurance Marketplaces, Insurers Return

August 14, 2019

Felicia Morrison is eager to find a health plan for next year that costs less than the one she has and covers more of the medical services she needs for her chronic autoimmune disease.

Morrison, a solo lawyer in Stockton, Calif., buys coverage for herself and her twin sons through Covered California, the state’s Affordable Care Act insurance marketplace. Morrison, 57, gets a federal subsidy to help pay for her coverage and she said that her monthly premium of $167 is manageable. But she spends thousands of dollars a year on deductibles, copayments and care not covered by her plan.

Felicia Morrison is eager to find a health plan for next year that costs less than the one she has and covers more of the medical services she needs for her chronic autoimmune disease.

Morrison, a solo lawyer in Stockton, Calif., buys coverage for herself and her twin sons through Covered California, the state’s Affordable Care Act insurance marketplace. Morrison, 57, gets a federal subsidy to help pay for her coverage and she said that her monthly premium of $167 is manageable. But she spends thousands of dollars a year on deductibles, copayments and care not covered by her plan.

“I would just like to have health insurance for a change that feels like it’s worth it and covers your costs,” she said….

Read the full Kaiser Health News article