Datapoint: Lynparza Scores Prostate Cancer Nod

May 26, 2020

The FDA last week approved AstraZeneca and Merck’s Lynparza for use in some treatment-resistant prostate cancers — the PARP inhibitor’s fourth oncology nod. For the treatment of triple-negative breast cancer, Lynparza currently holds preferred status for 4% of covered lives under the pharmacy benefit, growing to 41% with prior authorization and/or step therapy.

The FDA last week approved AstraZeneca and Merck’s Lynparza for use in some treatment-resistant prostate cancers — the PARP inhibitor’s fourth oncology nod. For the treatment of triple-negative breast cancer, Lynparza currently holds preferred status for 4% of covered lives under the pharmacy benefit, growing to 41% with prior authorization and/or step therapy.

SOURCE: MMIT Analytics, as of 5/20/20

Will COVID-19 Advance Automatic Health Insurance Enrollment?

May 26, 2020

As the COVID-19 pandemic continues to ravage the U.S. economy, it would seem to be the perfect time for policymakers to explore a policy option that has garnered rare bipartisan support: automatic health insurance enrollment.

“We have huge numbers of people who are losing employer-based coverage; most of them are eligible for some kind of help, but we know historically most laid-off workers do not enroll in coverage for which they qualify,” said Stan Dorn, director of the National Center for Coverage Innovation and senior fellow at Families USA. “It’s just overwhelming to be grappling with job loss and therefore it becomes imperative to make enrollment as easy, seamless and automatic as possible.”

By Leslie Small

As the COVID-19 pandemic continues to ravage the U.S. economy, it would seem to be the perfect time for policymakers to explore a policy option that has garnered rare bipartisan support: automatic health insurance enrollment.

“We have huge numbers of people who are losing employer-based coverage; most of them are eligible for some kind of help, but we know historically most laid-off workers do not enroll in coverage for which they qualify,” said Stan Dorn, director of the National Center for Coverage Innovation and senior fellow at Families USA. “It’s just overwhelming to be grappling with job loss and therefore it becomes imperative to make enrollment as easy, seamless and automatic as possible.”

Dorn was among several panelists who spoke during a May 18 webinar about automatic health insurance enrollment, hosted by the USC-Brookings Schaeffer Initiative for Health Policy and the American Enterprise Institute. Current crisis aside, Dorn said he advocates helping eligible uninsured individuals sign up for coverage when they’re filing their tax returns.

Christen Linke Young, a fellow at the USC-Brookings Schaeffer Initiative for Health Policy, said that “retroactive enrollment” is the best option. A federal “backstop” program would pay all claims for uninsured people when they receive care, but when filing taxes they would be responsible for paying income-adjusted premiums for the “plan” they used. “It’s the path toward universal coverage that is in my view most feasible,” she said.

Other panelists advocated for a more state-driven approach. One way to accomplish that would be for the federal government to create an incentive program that grants states new tools and authorities to build automatic enrollment programs, according to James Capretta, a visiting fellow at the American Enterprise Institute and senior fellow at the Ethics and Public Policy Center.

During the current pandemic-related economic downturn, one solution could be for states to move people who have lost their employer-based coverage to a comparable Affordable Care Act marketplace plan, suggested Lanhee Chen, a David and Diane Steffy fellow in American public policy studies at the Hoover Institution. “I think certainly that would be a more affordable route than, for example, subsidizing COBRA continuation coverage,” he said.

People on the Move

May 22, 2020

Outpatient Visits, Hospital Revenues Down During COVID-19 Outbreak

May 22, 2020

Due to the COVID-19 pandemic, the number of visits to ambulatory care practices dropped almost 60% in mid-March, according to a new analysis by researchers at Harvard University and health care technology company Phreesia. Surgical and procedural specialties saw the greatest impact, with the number of visits between March 1 and April 5 decreasing more than 60%. Meanwhile, a recent FAIR Health study reported that larger hospitals and health systems were hit harder financially by the pandemic. The average per-facility revenues based on estimated allowed amounts in large facilities decreased from $4.5 million in the first quarter of 2019 to $4.2 million in 2020.

by Jinghong Chen

Due to the COVID-19 pandemic, the number of visits to ambulatory care practices dropped almost 60% in mid-March, according to a new analysis by researchers at Harvard University and health care technology company Phreesia. Surgical and procedural specialties saw the greatest impact, with the number of visits between March 1 and April 5 decreasing more than 60%. Meanwhile, a recent FAIR Health study reported that larger hospitals and health systems were hit harder financially by the pandemic. The average per-facility revenues based on estimated allowed amounts in large facilities decreased from $4.5 million in the first quarter of 2019 to $4.2 million in 2020.

NOTES: The average per-facility revenues are based on estimated allowed amounts, which refer to the total fee negotiated between an insurance plan and a provider for an in-network service. The Consumer Price Index was used to adjust the 2019 numbers to reduce any confounding variables of chargemaster increases between 2019 and 2020 or rate negotiations between the two years.

SOURCES: “What Impact Has COVID-19 Had on Outpatient Visits?” Commonwealth Fund, April 2020. Visit https://bit.ly/35Ypyp2. “Illuminating the Impact of COVID-19 on Hospitals and Health Systems, A Comparative Study of Revenue and Utilization,” FAIR Health, Inc. Visit https://go.aws/2WT2SSG.

Datapoint: Centene Spearheads Health Disparities Task Force

May 21, 2020

Centene Corp. last week unveiled a new health disparities task force staffed with ten leaders spanning from the former vice president of the Navajo Nation to a hospital CEO in New Orleans. Centene will use the task force’s insights to study and address health disparities seen in its most vulnerable populations, paying particular attention to issues that have been exacerbated by the COVID-19 pandemic. Centene is currently the largest managed Medicaid payer in the U.S., serving 7.85 million lives (not accounting for its acquisition of WellCare Health Plans, Inc.). The insurer has recently expanded its presence in the Medicare Advantage sector, and currently enrolls 340,001 seniors and Medicare-Medicaid dual eligibles.

Centene Corp. last week unveiled a new health disparities task force staffed with ten leaders spanning from the former vice president of the Navajo Nation to a hospital CEO in New Orleans. Centene will use the task force’s insights to study and address health disparities seen in its most vulnerable populations, paying particular attention to issues that have been exacerbated by the COVID-19 pandemic. Centene is currently the largest managed Medicaid payer in the U.S., serving 7.85 million lives (not accounting for its acquisition of WellCare Health Plans, Inc.). The insurer has recently expanded its presence in the Medicare Advantage sector, and currently enrolls 340,001 seniors and Medicare-Medicaid dual eligibles.

Source: AIS’s Directory of Health Plans