News Briefs

News Briefs

August 19, 2019

✦ CMS is bringing the star rating system to the Affordable Care Act exchanges. Under the new Quality Rating System, all exchange plans will be given a rating on a scale of one to five based on three main factors: medical care, member experience and plan administration. Beginning with the 2020 open enrollment period, consumers shopping on the exchanges will see each plan’s five-star ranking.

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News Briefs

August 15, 2019

✦After some delay, the Louisiana Dept. of Health (LDH) on Aug. 5 said it intends to contract with four Medicaid managed care organizations, down from five MCOs that currently serve the state’s 1.7 million Healthy Louisiana enrollees. LDH selected AmeriHealth Caritas Louisiana, Community Care Health Plan of Louisiana (Healthy Blue — an Anthem, Inc./Amerigroup partnership with Blue Cross and Blue Shield of Louisiana), Humana Health Benefit Plan of Louisiana and UnitedHealthcare Community Plan. The awards are not final and are subject to negotiation and a protest period, which has the potential to delay the planned start date of Jan. 1, 2020. Contracts are to be executed on or about Aug. 23. CVS Health Corp.’s Aetna Better Health and Centene Corp.’s Louisiana Healthcare Connections were two incumbents not selected to renew. Centene currently has a 31% market share of the program and had the lowest technical score of all six bidders, which Jefferies analysts found to be “less than encouraging” ahead of new contract awards in Texas that are expected to be unveiled this month, according to an Aug. 8 research note from the firm.

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News Briefs

August 12, 2019

✦ The Louisiana Dept. of Health unveiled the winners of its managed Medicaid contract awards on Aug. 5, selecting AmeriHealth Caritas Louisiana, Community Care Health Plan of Louisiana (Healthy Blue), Humana Health Benefit Plan of Louisiana and United Healthcare Community Plan. Incumbents Centene Corp. and CVS Health Corp./Aetna were not awarded contracts — a “surprising loss” for Centene — while the addition of Humana was a “nice win” for the firm, Citi analyst Ralph Giacobbe advised investors. For Humana, “the win is incremental to earnings (1-2%) but more importantly speaks to its ability to win organically, perhaps without the need for acquisition in the Medicaid space,” he wrote. The new contracts are effective January 2020.

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News Briefs

August 8, 2019

✦ A U.S. district court ruled on July 31 that the Pharmaceutical Research and Manufacturers of America (PhRMA) can proceed with an amended lawsuit that challenges California’s law requiring drug manufacturers to provide advance notice and justification for price hikes, Stat reported. PhRMA contends that the law — which will remain intact while litigation continues — is unconstitutional. Two days earlier, California Attorney General Xavier Becerra said the state reached settlements with Teva Pharmaceutical Industries Ltd., Endo Pharmaceuticals Inc. and Teikoku Pharma USA Inc. to resolve claims they engaged in “pay for delay” practices — when pharmaceutical firms pay generic drugmakers to delay bringing cheaper versions of branded drugs to the market. The three drugmakers will pay the state nearly $70 million.

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News Briefs

August 5, 2019

✦ CMS said July 30 the Medicare Part D national average monthly bid amount for 2020 is $47.59, the 2020 Part D base beneficiary premium is $32.74, and the de minimis amount is $2. For the third year in a row, the average basic premium for Part D prescription drug plans (PDPs) is projected to decline, the agency noted. Over the three years, average Part D basic premiums have dropped by 13.5%, saving beneficiaries about $1.9 billion in premium costs over that time period, CMS said. The agency added that the continued decline in Part D bid amounts over the past few years has saved taxpayers nearly $6 billion in lower Medicare premium subsidies.

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News Briefs

August 1, 2019

✦ The average monthly premium for basic Medicare Part D coverage will decline for the third year in a row to a projected $30 in 2020, according to new estimates from CMS. The basic Part D premium rose between 2013 and 2017, when it peaked at $34.70 and began declining, CMS said on July 30. Meanwhile, the 2020 Part D national average monthly bid amount, which is a weighted average of the standardized bid amounts for each Part D plan, is $47.59, compared with $51.28 for 2019, estimated CMS. And the base beneficiary premium, which is the product of the beneficiary premium percentage and the national average bid amount, is projected to be $32.74, down from $33.19. View the 2020 bid-related information at https://go.cms.gov/2ytp61K.

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