Datapoint

Datapoint: Keytruda Approved for Rare Bladder Cancer

January 14, 2020

The FDA last week approved Merck & Co.’s Keytruda for non-muscle-invasive bladder cancer, a rare form of the disease that does not respond well to other treatments. Keytruda is the first new approval in the space in more than 20 years. For the treatment of urothelial carcinoma, the most common form of bladder cancer, Keytruda is currently one of the most advantaged therapies on the market, holding preferred status for 10% of all covered lives in the pharmacy benefit, growing to 14% with prior authorization and/or step therapy.

The FDA last week approved Merck & Co.’s Keytruda for non-muscle-invasive bladder cancer, a rare form of the disease that does not respond well to other treatments. Keytruda is the first new approval in the space in more than 20 years. For the treatment of urothelial carcinoma, the most common form of bladder cancer, Keytruda is currently one of the most advantaged therapies on the market, holding preferred status for 10% of all covered lives in the pharmacy benefit, growing to 14% with prior authorization and/or step therapy.

SOURCE: MMIT Analytics, as of 1/10/20

Datapoint: Magellan Expands Offerings to Include Plans for Dual Eligibles

January 13, 2020

Magellan Health has expanded its 2020 offerings to include Special Needs Plans for Medicare-Medicaid dual eligibles in Arizona and Virginia. The company’s insurance unit currently enrolls 98,233 people in Arizona, Florida and Virginia’s managed Medicaid programs. As of December 2019, more than 2.3 million people are enrolled in a Dual Eligible Special Needs Plan, with UnitedHealthcare dominating the market at 39.8% market share.

Magellan Health has expanded its 2020 offerings to include Special Needs Plans for Medicare-Medicaid dual eligibles in Arizona and Virginia. The company’s insurance unit currently enrolls 98,233 people in Arizona, Florida and Virginia’s managed Medicaid programs. As of December 2019, more than 2.3 million people are enrolled in a Dual Eligible Special Needs Plan, with UnitedHealthcare dominating the market at 39.8% market share.

Source: AIS’s Directory of Health Plans

Datapoint: Molina to Acquire NextLevel Health

January 9, 2020

Molina Healthcare this week said it has entered an agreement to acquire NextLevel Health Partners, a Medicaid plan in Illinois. The move would add 51,197 lives to Molina’s existing Illinois Medicaid plan, a 23.8% boost. Molina is currently the fifth-largest Medicaid insurer in Illinois, with 215,099 members.

Molina Healthcare this week said it has entered an agreement to acquire NextLevel Health Partners, a Medicaid plan in Illinois. The move would add 51,197 lives to Molina’s existing Illinois Medicaid plan, a 23.8% boost. Molina is currently the fifth-largest Medicaid insurer in Illinois, with 215,099 members.

Source: AIS’s Directory of Health Plans

Datapoint: CMS Approves Full Medicaid Expansion, Work Requirement in Utah

January 8, 2020

CMS last month approved Utah’s “fallback” request to fully expand Medicaid in the state, a move that will add about 120,000 people to the state’s rolls. The state initially asked for a partial expansion with the same amount of federal funding, which was denied. The fallback plan, while expanding coverage to a greater number of people, called for a work requirement to apply to certain adults, which CMS also approved. Utah’s Medicaid program currently enrolls 302,683 people, with 75.3% enrolled in managed care plans.

CMS last month approved Utah’s “fallback” request to fully expand Medicaid in the state, a move that will add about 120,000 people to the state’s rolls. The state initially asked for a partial expansion with the same amount of federal funding, which was denied. The fallback plan, while expanding coverage to a greater number of people, called for a work requirement to apply to certain adults, which CMS also approved. Utah’s Medicaid program currently enrolls 302,683 people, with 75.3% enrolled in managed care plans.

Source: AIS’s Directory of Health Plans

Datapoint: Rhode Island Implements Insurance Mandate

January 7, 2020

Rhode Island’s statewide individual insurance mandate, which requires residents to have minimum essential health coverage or face a tax penalty, went into effect on Jan. 1. About 1.03 million Rhode Island residents currently have full medical coverage, according to the latest update to AIS’s Directory of Health Plans. Based on 2019 U.S. census estimates, just 3-4% of Rhode Islanders are uninsured.

Rhode Island’s statewide individual insurance mandate, which requires residents to have minimum essential health coverage or face a tax penalty, went into effect on Jan. 1. About 1.03 million Rhode Island residents currently have full medical coverage, according to the latest update to AIS’s Directory of Health Plans. Based on 2019 U.S. census estimates, just 3-4% of Rhode Islanders are uninsured.

Source: AIS’s Directory of Health Plans

Datapoint: CareFirst to Acquire Two Medicaid Plans in DC and Maryland

January 6, 2020

CareFirst BlueCross BlueShield will add 79,819 managed Medicaid and CHIP members to its roster with its planned acquisitions of the Baltimore-based University of Maryland Health Partners, and Trusted Health Plan in Washington, D.C. The deals, once finalized, will mark CareFirst’s first foray into the Medicaid market in about two decades. The insurer currently serves 2,410,049 members in Maryland, Virginia and Washington, D.C.

CareFirst BlueCross BlueShield will add 79,819 managed Medicaid and CHIP members to its roster with its planned acquisitions of the Baltimore-based University of Maryland Health Partners, and Trusted Health Plan in Washington, D.C. The deals, once finalized, will mark CareFirst’s first foray into the Medicaid market in about two decades. The insurer currently serves 2,410,049 members in Maryland, Virginia and Washington, D.C.

Source: AIS’s Directory of Health Plans