July

Centene, Anthem Go on Defensive About MLR Results

July 29, 2019

For Centene Corp. and Anthem, Inc., otherwise solid second-quarter earnings results were overshadowed by analysts’ concerns about elevated medical loss ratio (MLR) trends — which the insurers’ top executives did their best to dispel. When Centene reported its earnings on July 23, it recorded an MLR of 86.7% for the quarter, which came in higher than the Street’s consensus of 86.3%, Citi analyst Ralph Giacobbe advised investors in a July 23 note. “Interestingly, the company attributed the higher MLR in part to normalizing margins on the HIX [health insurance exchange],” Giacobbe added.

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How Louisiana’s Hepatitis C Drug Payment Model Took Shape

July 29, 2019

Beginning this month, Louisiana has been able to treat hundreds of patients who were waiting to receive a cure for hepatitis C thanks to an innovative “modified subscription model” in which the state pays a fixed amount to a manufacturer for a drug, up to a spending cap, and in return gets unlimited access to the therapy for Medicaid beneficiaries. But the road to get there was long and difficult, according to Rebekah Gee, M.D., secretary of the Louisiana Dept. of Health, who, during a July 22 event hosted by the Brookings Institution, detailed the challenges she faced in trying to get a costly curative therapy to more people while facing down a $2 billion budget deficit.

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Are Some Plans’ Enrollment Declines Due to STLDI Sales?

July 29, 2019

A national trade group of 66 safety-net plans recently failed to persuade a federal judge, by its submission of some plan enrollment data, that the Trump administration’s rule promoting the sale of short-term limited duration insurance (STLDI) resulted in their membership declines. Yet the Association for Community Affiliated Plans (ACAP) — whose members collectively cover 20 million-plus people with low incomes or significant health needs through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP) and Affordable Care Act (ACA) individual-market exchanges — says it is undaunted by Judge Richard Leon’s ruling to uphold regulations allowing the sale of non-ACA-compliant short-term plans and confident of a successful appeal. The ACAP-led lawsuit was filed last September, shortly before the Trump administration’s rule on short-term plans took effect.

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Major Market Entrances and Expansions From December 2018 to June 2019, at a Glance

July 29, 2019

by Jinghong Chen Over the past six months, several insurers made major market entrances or expansions, according to AIS’s Directory of Health Plans. Following expansions in several states, Bright Health increased its membership by almost 170% in the commercial risk market over the past half year, primarily in the individual market. Tufts Health Plan entered […]

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News Briefs

July 29, 2019

✦ The Trump administration’s proposal to overhaul the prescription drug rebate system in government insurance plans — which it recently scrapped — may not be dead yet. Senate Finance Committee Chairman Chuck Grassley (R-Iowa) wants to include a version of the rule in the final version of his newly released drug pricing reform bill, CNBC reported. The rule would have removed safe-harbor protections under the federal anti-kickback statute for rebates paid by drug manufacturers to PBMs, Part D plans and Medicaid managed care organizations, and it would have created a new safe-harbor protection for point-of-sale drug discounts. But the administration pulled it amid concerns that it would raise Part D premiums. Grassley’s bill, which cleared the Senate Finance Committee on July 25, would also put inflation caps on Medicare Part D and Part B drug prices.

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Even Absent Rebate Rule, Storm Clouds Gather for PBMs

July 25, 2019

Now that the Trump administration has abandoned its bid to overhaul the Medicare Part D drug rebate system (RDB 7/11/19, p. 8), all eyes are on what Congress will do to address the ever-vexing problem of high drug prices.

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