News Briefs

News Briefs

October 17, 2019

✦ A UnitedHealthcare subsidiary serving about 42,000 Medicare Advantage Prescription Drug (MA-PD) plan members was barred from enrolling new beneficiaries this Annual Election Period for a failure to maintain a medical loss ratio (MLR) of at least 85%. According to a CMS letter dated Sept. 11 and recently posted to the CMS Part C and Part D Enforcement Page, Care Improvement Plus South Central Insurance Co. reported MLRs of 71.3% for calendar year 2016, 83.9% for CY 2017, and 84.1% for CY 2018. As a result, it will be removed from the list of MA-PD plans available for selection on the Medicare Plan Finder for 2020. If the plan submits a CY 2019 report next year that indicates it has achieved an MLR of at least 85%, it will be allowed to accept enrollments for 2021, said CMS. Visit www.cms.gov.

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News Briefs

October 14, 2019

✦ Based on an early analysis of star ratings that CMS recently published for Medicare Advantage plans on the new Medicare Plan Finder, one Wall Street analyst saw “no surprise stars.” Humana Inc. and UnitedHealth Group both maintained an average 4-star-plus rating, Citi analyst Ralph Giacobbe found, while Aetna (owned by CVS Health Corp.) improved to over 4 stars. Cigna Corp. also scored above 4, while Anthem, Inc. and Centene Corp. “scored just below the threshold based on our initial analysis,” Giacobbe noted.

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News Briefs

October 10, 2019

✦ Michigan is planning to shift the management of Medicaid beneficiaries’ pharmacy benefits from managed care back to the state. In a Sept. 30 proposed policy draft, the Michigan Department of Health and Human Services (MDHHS) wrote that as of Dec. 1, all pharmacy drug coverage will be transitioned to fee-for-service Medicaid, arguing that the move “will result in cost savings through a combination of increased pharmaceutical rebates and elimination of related MHP [Medicaid Health Plan] administrative capitation costs.” CVS Health Corp., UnitedHealth Group’s OptumRx, MedImpact Healthcare Systems, Inc. and “a handful of other PBMs stand to lose business based on the state’s proposed policy,” Citi analyst Ralph Giacobbe advised investors. The move to a single Medicaid formulary, which is opposed by the Michigan Association of Health Plans, was tried by former Gov. Rick Synder (R) in 2015, but he ultimately reversed course amid industry opposition, Crain’s Detroit Business noted. See https://bit.ly/2orUYT5 and https://bit.ly/2ASyDkd.

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News Briefs

October 7, 2019

✦ President Donald Trump on Sept. 3 signed an executive order that is meant to be a counterpoint to Medicare for All proposals. The order directs the HHS secretary to devise a regulation that adjusts Medicare Advantage supplemental benefits to allow Medicare beneficiaries to “share more directly in the savings from the program, including through cash or monetary rebates.” It also tells HHS to “encourage innovative MA benefit structures and plan designs, including through changes in regulations and guidance that reduce barriers to obtaining Medicare Medical Savings Accounts and that promote innovations in supplemental benefits and telehealth services.”

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News Briefs

October 3, 2019

President Trump at press time was planning to issue an executive order on the future of Medicare that could include goals for strengthening Medicare Advantage, according to news reports. Trump was scheduled to appear in Florida on Oct. 3 to give a speech on his health policy track record and unveil the executive order, dubbed “Protecting Medicare from Socialist Destruction,” Bloomberg reported. It could lead to rulemaking on expanding telehealth and supplemental benefits, according to the Washington Examiner. Visit www.whitehouse.gov.

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News Briefs

October 1, 2019

✦ The FDA unveiled Project Orbis, an initiative focused on simultaneous submission and review of oncology products among the agency and international partners. The first approval was announced Sept. 17 (see brief, p. 8); it was given through a collaboration involving the FDA, the Australian Therapeutic Goods Administration and Health Canada, all of which simultaneously approved Eisai Inc.’s Lenvima (lenvatinib) and Merck & Co., Inc.’s Keytruda (pembrolizumab) as a combination therapy for certain types of advanced endometrial carcinoma. In an FAQ on the initiative, the FDA said other countries may be involved in future reviews. The goal of this first review, it said, was “to identify any regulatory divergence across the review teams.” While both drugs already had FDA approval for other uses, the agency said it would discuss with the other agencies “the possibility of collaborating” on a New Drug Application or Biologics License Application for oncology products, “but the process may be more complex due to proprietary information involved.” View the FAQ at https://bit.ly/2kmwl8x.

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