April

Anthem, Centene Focus on PBM Businesses in 1Q Earnings

April 29, 2019

Following UnitedHealth Group’s lead (HPW 4/22/19, p. 3), Anthem, Inc. reported strong financial results for the first three months of 2019. The Blues giant cited rising profits and raised its 2019 outlook, with its chief executive touting earnings “driven by our strongest risk-based growth in nearly a decade.” Unlike UnitedHealth, Anthem didn’t mention Medicare for All or other health policy issues sparking recent investor concerns and tumbling stock prices, though Anthem’s management team touched on drug rebates at one point. Instead, much of Anthem’s April 24 earnings call focused on its soon-to-launch in-house PBM IngenioRx (HPW 2/4/19, p. 3) and implications of UnitedHealth’s exit from Iowa’s Medicaid managed care program.

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Payers May Benefit as Health Systems Build Micro Hospitals

April 29, 2019

Health systems are turning to micro hospitals — small inpatient facilities with emergency departments and eight to 25 beds that include full services, such as labs and imaging — as a way to provide community-based care that’s more patient-centric and potentially significantly more cost-effective than traditional emergency care. When they include these facilities in networks, stakeholders say, payers can drive emergency care to facilities less costly than traditional emergency departments.

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Medicaid Churn Poses Multiple Challenges for Health Plans

April 29, 2019

Newly implemented state paperwork requirements caused around 1.6 million Medicaid beneficiaries to lose coverage in 2018, the advocacy group Families USA says, and Medicaid managed care stakeholders say that this additional churn in Medicaid enrollment poses challenges for plans that can drive up costs and make ensuring continuity of care more difficult. But one expert counters that redeterminations are necessary to prevent fraud.

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Centene Gives Pharma Update, Touts RxAdvance in 1Q Earnings

April 29, 2019

When it comes to pharma-related matters, Centene Corp., in its first-quarter 2019 earnings call, highlighted its interesting position in an industry awash in multi-layered deal-making. The St. Louis-based managed care giant also gave more broad insight into its PBM strategy going forward, indicating that decisions are likely within the next two months

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Key Financial Data for Leading Health Plans — Fourth Quarter 2018 Year-to-Date

April 29, 2019

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News Briefs

April 29, 2019

✦ For the first three months of 2019, America’s Health Insurance Plans (AHIP) spent $2.88 million on lobbying, including on Medicare for All, according to disclosures that had to be filed with Congress by April 22, Bloomberg reports. That figure was up more than 87% from the previous quarter and a 26% increase from a year earlier, the news outlet said. By comparison, the Pharmaceutical Research and Manufacturers of America (PhRMA) spent $9.91 million in this year’s first quarter, up from $6.03 million during the fourth quarter of 2018.

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