Datapoint

Datapoint: Sanford Health, UnityPoint Explore Merger

July 3, 2019

Two Midwest-based health systems, Sanford Health and UnityPoint Health, have signed a letter of intent to merge, the companies announced last week. The joint entity would own more than 70 hospitals in 26 states. Sanford also operates Sanford Health Plan, a health insurer with 186,584 members in Iowa, Minnesota, North Dakota and South Dakota. More than half (51.4%) of its members are enrolled in group risk plans.

Two Midwest-based health systems, Sanford Health and UnityPoint Health, have signed a letter of intent to merge, the companies announced last week. The joint entity would own more than 70 hospitals in 26 states. Sanford also operates Sanford Health Plan, a health insurer with 186,584 members in Iowa, Minnesota, North Dakota and South Dakota. More than half (51.4%) of its members are enrolled in group risk plans.

Source: AIS’s Directory of Health Plans

Datapoint: Dupixent Scores FDA Nod for Sinusitis

July 2, 2019

Sanofi and Regeneron’s Dupixent last week scored an FDA approval for a third indication — the treatment of sinusitis with nasal polyps. The drug will be the first biologic therapy to treat the condition. For the treatment of asthma, Dupixent currently holds preferred status for just 1% of covered lives, growing to 20% with prior authorization and/or step therapy. The therapy is not covered for 13% of lives.

Sanofi and Regeneron’s Dupixent last week scored an FDA approval for a third indication — the treatment of sinusitis with nasal polyps. The drug will be the first biologic therapy to treat the condition. For the treatment of asthma, Dupixent currently holds preferred status for just 1% of covered lives, growing to 20% with prior authorization and/or step therapy. The therapy is not covered for 13% of lives.

SOURCE: MMIT Analytics, as of 6/28/19

Datapoint: Blue Shield of California Launches New Digital Wellness Platform

July 1, 2019

Blue Shield of California last week revealed its revamped Wellvolution platform, created in partnership with Solera Health. Members can use online apps and in-person lifestyle programs to address issues that can vastly improve overall health and prevent disease, such as sleep quality, exercise, diet and tobacco cessation. Blue Shield of California is currently the third-largest insurer in California, with 3,371,824 members. Just over half of its members (51.3%) are enrolled in group risk plans.

Blue Shield of California last week revealed its revamped Wellvolution platform, created in partnership with Solera Health. Members can use online apps and in-person lifestyle programs to address issues that can vastly improve overall health and prevent disease, such as sleep quality, exercise, diet and tobacco cessation. Blue Shield of California is currently the third-largest insurer in California, with 3,371,824 members. Just over half of its members (51.3%) are enrolled in group risk plans.

Source: AIS’s Directory of Health Plans

Datapoint: Gilenya Wards Off Generic Competition With Court Order

June 27, 2019

Novartis this week scored a victory for its bestselling multiple sclerosis (MS) therapy, Gilenya, winning a temporary injunction against generic competitor launches from Dr. Reddy’s Laboratories and Mylan. The U.S. district judge in Delaware said the generic launches would jeopardize Novartis’ current patent litigation for the drug. For the treatment of MS, Gilenya currently holds preferred status for 13% of covered lives, growing to 48% with prior authorization and/or step therapy.

Novartis this week scored a victory for its bestselling multiple sclerosis (MS) therapy, Gilenya, winning a temporary injunction against generic competitor launches from Dr. Reddy’s Laboratories and Mylan. The U.S. district judge in Delaware said the generic launches would jeopardize Novartis’ current patent litigation for the drug. For the treatment of MS, Gilenya currently holds preferred status for 13% of covered lives, growing to 48% with prior authorization and/or step therapy.

SOURCE: MMIT Analytics, as of 6/26/19

Datapoint: Amerigroup Georgia Adds New Benefits to Address SDOH

June 26, 2019

Amerigroup Community Care, Anthem Inc.’s Medicaid unit in Georgia, announced June 20 that it is adding new benefits to support enrolled families with children, and address social determinants of health that can make Medicaid members more expensive to insure. The no-cost benefits include tutoring programs and SAT preparation for older children, and free baby food for infants following their 6-month check-up. Amerigroup currently serves 375,471 Medicaid and CHIP members in Georgia, 26.2% of the state’s managed Medicaid lives.

Amerigroup Community Care, Anthem Inc.’s Medicaid unit in Georgia, announced June 20 that it is adding new benefits to support enrolled families with children, and address social determinants of health that can make Medicaid members more expensive to insure. The no-cost benefits include tutoring programs and SAT preparation for older children, and free baby food for infants following their 6-month check-up. Amerigroup currently serves 375,471 Medicaid and CHIP members in Georgia, 26.2% of the state’s managed Medicaid lives.

Source: AIS’s Directory of Health Plans

Datapoint: ICER Rules That Mayzent and Spravato Are Not Cost Effective

June 25, 2019

The Institute for Clinical and Economic Review (ICER) last week ruled two highly anticipated (and potential blockbuster) drugs, Novartis’ Mayzent and Janssen’s Spravato, are not cost effective. The nonprofit industry watchdog said Spravato, which holds covered status for just 3% of all insured lives, should lower its list price by 25% to 52%. In Mayzent’s case, ICER said payers should grant preferred formulary status to a generic variant of Novartis’ Gilenya instead, once it hits the market. For the treatment of Multiple Sclerosis, Mayzent currently holds preferred status for 6% of covered lives, with step therapy and/or prior authorization.

The Institute for Clinical and Economic Review (ICER) last week ruled two highly anticipated (and potential blockbuster) drugs, Novartis’ Mayzent and Janssen’s Spravato, are not cost effective. The nonprofit industry watchdog said Spravato, which holds covered status for just 3% of all insured lives, should lower its list price by 25% to 52%. In Mayzent’s case, ICER said payers should grant preferred formulary status to a generic variant of Novartis’ Gilenya instead, once it hits the market. For the treatment of Multiple Sclerosis, Mayzent currently holds preferred status for 6% of covered lives, with step therapy and/or prior authorization.

SOURCE: MMIT Analytics, as of 6/24/19