Datapoint

Datapoint: BCBS Nebraska to Expand 2020 MA Offerings

November 4, 2019

Blue Cross and Blue Shield of Nebraska will expand its 2020 Medicare Advantage (MA) offerings to 11 new counties in the state, bringing its total reach to 26 counties. The insurer currently enrolls just 1,434 MA members, but is still the fifth-largest provider of MA plans in the state.

Blue Cross and Blue Shield of Nebraska will expand its 2020 Medicare Advantage (MA) offerings to 11 new counties in the state, bringing its total reach to 26 counties. The insurer currently enrolls just 1,434 MA members, but is still the fifth-largest provider of MA plans in the state.

Source: AIS’s Directory of Health Plans

Datapoint: Amgen Standardizes Lower List Price for Repatha

October 31, 2019

Amgen last week said it will standardize the lower list price for its leading PCSK9 inhibitor, Repatha, by the end of 2020. The drug’s previous list price was $14,520, which the manufacturer dropped by 60% to $5,860 for those paying out of pocket. The change will put the lower list price in effect for all insurers. For the treatment of atherosclerotic cardiovascular disease in the pharmacy benefit, Repatha holds preferred status for just 2% of covered lives, though this grows to 49% with prior authorization and/or step therapy.

Amgen last week said it will standardize the lower list price for its leading PCSK9 inhibitor, Repatha, by the end of 2020. The drug’s previous list price was $14,520, which the manufacturer dropped by 60% to $5,860 for those paying out of pocket. The change will put the lower list price in effect for all insurers. For the treatment of atherosclerotic cardiovascular disease in the pharmacy benefit, Repatha holds preferred status for just 2% of covered lives, though this grows to 49% with prior authorization and/or step therapy.

SOURCE: MMIT Analytics, as of 10/29/19

Datapoint: ACA Benchmark Plan Premiums Drop 4% for 2020

October 30, 2019

CMS last week said the average premium for benchmark plans (or second lowest-cost silver plans), the most common type of coverage received on the Affordable Care Act exchanges, will decrease by 4% in 2020. The agency also said the total number of insurers participating on the exchanges will increase to 175, 20 more than 2019. According to the latest update to AIS’s Directory of Health Plans, 11,127,222 people currently receive coverage through the exchanges.

CMS last week said the average premium for benchmark plans (or second lowest-cost silver plans), the most common type of coverage received on the Affordable Care Act exchanges, will decrease by 4% in 2020. The agency also said the total number of insurers participating on the exchanges will increase to 175, 20 more than 2019. According to the latest update to AIS’s Directory of Health Plans, 11,127,222 people currently receive coverage through the exchanges.

Source: AIS’s Directory of Health Plans

Datapoint: Group Health Cooperative Faces Whistleblower Lawsuit

October 29, 2019

Seattle-based insurer Group Health Cooperative is the subject of a whistleblower lawsuit that alleges the company manipulated its Medicare Advantage risk scores to receive additional reimbursement dollars from the federal government. The allegations date back to 2012. Kaiser Permanente acquired the renowned health plan, now known as Kaiser Foundation Health Plan of Washington, in 2017. The insurer currently serves 698,305 members, with 13.6% enrolled in Medicare Advantage products.

Seattle-based insurer Group Health Cooperative is the subject of a whistleblower lawsuit that alleges the company manipulated its Medicare Advantage risk scores to receive additional reimbursement dollars from the federal government. The allegations date back to 2012. Kaiser Permanente acquired the renowned health plan, now known as Kaiser Foundation Health Plan of Washington, in 2017. The insurer currently serves 698,305 members, with 13.6% enrolled in Medicare Advantage products.

Source: AIS’s Directory of Health Plans

Datapoint: Arizona Suspends Medicaid Work Requirements

October 28, 2019

Citing ongoing legal challenges in other states, Arizona has suspended implementation of its Medicaid work requirements program, which was set to begin Jan. 1, according to an Oct. 17 letter from the state to CMS. About 7% of Arizona’s 1,730,071 Medicaid beneficiaries would have been affected by the new program at launch. While work requirements have proved a popular reform idea in many states, implementation of approved changes has been rocky, as legal arguments in favor of the programs have not held up in court, and administrative changes proved more of a strain on state budgets than originally thought.

Citing ongoing legal challenges in other states, Arizona has suspended implementation of its Medicaid work requirements program, which was set to begin Jan. 1, according to an Oct. 17 letter from the state to CMS. About 7% of Arizona’s 1,730,071 Medicaid beneficiaries would have been affected by the new program at launch. While work requirements have proved a popular reform idea in many states, implementation of approved changes has been rocky, as legal arguments in favor of the programs have not held up in court, and administrative changes proved more of a strain on state budgets than originally thought.

Source: AIS’s Directory of Health Plans

Datapoint: Centene-WellCare Deal Wins Approval From Five More States

October 24, 2019

Centene Corp. and WellCare Health Plans Inc. last week received regulatory approval from five more states, Arizona, Connecticut, Georgia, Ohio and Texas, for their pending merger. The Department of Justice has yet to approve the deal, though the companies say they hope to finalize in the first half of 2020. The combined company would serve 18,527,806, including 21.5% of the national managed Medicaid market.

Centene Corp. and WellCare Health Plans Inc. last week received regulatory approval from five more states, Arizona, Connecticut, Georgia, Ohio and Texas, for their pending merger. The Department of Justice has yet to approve the deal, though the companies say they hope to finalize in the first half of 2020. The combined company would serve 18,527,806, including 21.5% of the national managed Medicaid market.

Source: AIS’s Directory of Health Plans