Datapoint

Datapoint: Blue Cross NC Will Pay Docs to Switch to Value-Based Care

July 1, 2020

Blue Cross and Blue Shield of North Carolina last week launched its Accelerate to Value program, an initiative that will incentivize independent primary care groups in North Carolina to transition to value-based care. Beginning in September, participating practices will receive direct payments from the insurer based on 2019 revenue, which will continue into 2021. By the end of 2020, the providers must join one of Blue Cross NC’s existing accountable care organizations or work with Aledade to transition independently. Blue Cross NC is currently the largest insurer in North Carolina, serving 2,593,316 members.

Blue Cross and Blue Shield of North Carolina last week launched its Accelerate to Value program, an initiative that will incentivize independent primary care groups in North Carolina to transition to value-based care. Beginning in September, participating practices will receive direct payments from the insurer based on 2019 revenue, which will continue into 2021. By the end of 2020, the providers must join one of Blue Cross NC’s existing accountable care organizations or work with Aledade to transition independently. Blue Cross NC is currently the largest insurer in North Carolina, serving 2,593,316 members.

Source: AIS’s Directory of Health Plans

Datapoint: Cigna and Oscar Reveal First Cobranded Small Group Markets

June 30, 2020

Cigna Corp. and Oscar Health last week revealed the first markets for their new cobranded fully insured commercial products for the small group market. The new plans, set to launch in the fourth quarter of 2020, will be available in the San Francisco Bay Area, Atlanta and four cities in Tennessee; Chattanooga, Knoxville, Memphis and Nashville. The products will integrate primary medical, behavioral health and pharmacy benefits, as well as a 24/7 telemedicine service, according to both companies. About 12 million people are currently enrolled in small group plans, with Cigna and Oscar both holding relatively small shares of the market, at 43,795 and 18,818 lives, respectively.

Cigna Corp. and Oscar Health last week revealed the first markets for their new cobranded fully insured commercial products for the small group market. The new plans, set to launch in the fourth quarter of 2020, will be available in the San Francisco Bay Area, Atlanta and four cities in Tennessee; Chattanooga, Knoxville, Memphis and Nashville. The products will integrate primary medical, behavioral health and pharmacy benefits, as well as a 24/7 telemedicine service, according to both companies. About 12 million people are currently enrolled in small group plans, with Cigna and Oscar both holding relatively small shares of the market, at 43,795 and 18,818 lives, respectively.

Source: AIS’s Directory of Health Plans

Datapoint: Aetna Inks Deal to Expand Illinois Provider Network

June 29, 2020

CVS Health’s Aetna on June 19 inked a deal with DuPage Medical Group, a physician group serving more than 100 locations in the greater Chicago area, to expand its provider network for select Medicare Advantage members. Aetna currently serves 113,089 Medicare Advantage members in Illinois, but the deal only applies to about 50,000.

CVS Health’s Aetna on June 19 inked a deal with DuPage Medical Group, a physician group serving more than 100 locations in the greater Chicago area, to expand its provider network for select Medicare Advantage members. Aetna currently serves 113,089 Medicare Advantage members in Illinois, but the deal only applies to about 50,000.

Source: AIS’s Directory of Health Plans

Datapoint: Biogen Suffers Tecfidera Patent Loss

June 25, 2020

Biogen last week suffered a blow in federal court, when a judge ruled one if its remaining patents for Tecfidera, a multiple sclerosis drug, invalid. This paves the way for Mylan’s generic Tecfidera, which still must earn FDA approval. For the treatment of multiple sclerosis under the pharmacy benefit, Tecfidera currently holds preferred status for 12% of all covered lives, growing to 53% with prior authorization and/or step therapy.

Biogen last week suffered a blow in federal court, when a judge ruled one if its remaining patents for Tecfidera, a multiple sclerosis drug, invalid. This paves the way for Mylan’s generic Tecfidera, which still must earn FDA approval. For the treatment of multiple sclerosis under the pharmacy benefit, Tecfidera currently holds preferred status for 12% of all covered lives, growing to 53% with prior authorization and/or step therapy.

SOURCE: MMIT Analytics, as of 6/24/20

Datapoint: Cigna Expands Michigan Network With Priority Health Deal

June 24, 2020

Cigna Corp. and Priority Health on Monday said they have formed a strategic alliance to offer a more comprehensive provider network to Michigan employer groups. Beginning January 1, 2021, Cigna’s employer groups will have access to Priority Health’s provider network, and Priority Health’s members will be able to use Cigna’s network when travelling outside of the Priority Health service area. Priority Health is currently the second-largest insurer in Michigan, with 842,565 members. Just over 40% of its members are enrolled in a group risk plan. Cigna currently serves 120,639 members in Michigan, with 6,456 enrolled in a group risk plan.

Cigna Corp. and Priority Health on Monday said they have formed a strategic alliance to offer a more comprehensive provider network to Michigan employer groups. Beginning January 1, 2021, Cigna’s employer groups will have access to Priority Health’s provider network, and Priority Health’s members will be able to use Cigna’s network when travelling outside of the Priority Health service area. Priority Health is currently the second-largest insurer in Michigan, with 842,565 members. Just over 40% of its members are enrolled in a group risk plan. Cigna currently serves 120,639 members in Michigan, with 6,456 enrolled in a group risk plan.

Source: AIS’s Directory of Health Plans

Datapoint: Novartis Scores New Indication for Cosentyx

June 23, 2020

The FDA last week approved Novartis’ Cosentyx for the treatment of non-radiographic axial spondyloarthritis in adult patients. Cosentyx is the second IL-17 inhibitor to earn this status in a matter of weeks, coming in just behind Eli Lilly’s Taltz, cementing the two drugs’ rival status. For the treatment of ankylosing spondylitis, Cosentyx holds preferred status for 2% of covered lives under the pharmacy benefit, growing to 40% with prior authorization and/or step therapy. Meanwhile, in the same indication the Taltz autoinjector holds preferred status for less than 1% of covered lives, growing to 10% with PA/ST.

The FDA last week approved Novartis’ Cosentyx for the treatment of non-radiographic axial spondyloarthritis in adult patients. Cosentyx is the second IL-17 inhibitor to earn this status in a matter of weeks, coming in just behind Eli Lilly’s Taltz, cementing the two drugs’ rival status. For the treatment of ankylosing spondylitis, Cosentyx holds preferred status for 2% of covered lives under the pharmacy benefit, growing to 40% with prior authorization and/or step therapy. Meanwhile, in the same indication the Taltz autoinjector holds preferred status for less than 1% of covered lives, growing to 10% with PA/ST.

SOURCE: MMIT Analytics, as of 6/17/20