News Briefs

News Briefs

August 10, 2020

✦ CMS said on Aug. 4 that in light of the COVID-19 public health emergency, it will allow insurers operating in the individual and small-group markets to offer one or more months of temporary premium reductions for customers this year. Insurers in those markets are generally prohibited from changing premiums midway through the year. Previously, CMS permitted HealthCare.gov issuers to extend premium payment deadlines and delay cancellation for non-payment of premiums, and it allowed them to prepay to enrollees all or part of the estimated medical loss ratio rebate for the 2019 MLR reporting year.

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News Briefs

August 6, 2020

✦ The Dept. of Justice (DOJ) on Aug. 4 filed a complaint-in-intervention in the U.S. District Court for the Southern District of New York, alleging that Cigna Corp. and its affiliates submitted false and fraudulent risk adjustment claims to CMS resulting in overpayments of more than $1.4 billion. The suit, U.S. ex rel. Robert A. Cutler v. Cigna Corp (7:17-cv-07515-KMK), details an enhanced wellness visit program, known as the “360 Program,” that Cigna-HealthSpring allegedly used to identify health conditions that could raise the risk scores of Medicare Advantage plan members and therefore increase plan payments. The complaint was originally brought by an officer of Texas Health Management, a service provider of Cigna-HealthSpring between 2012 and 2017. Cigna in its latest 10Q filing with the U.S. Securities and Exchange Commission pointed out that the DOJ is conducting an “industry-wide investigation” of MAOs’ risk adjustment practices and said it “will continue to cooperate with the DOJ’s investigation.” The DOJ earlier this year filed a similar suit against Anthem, Inc. Visit https://bit.ly/31ldaNM.

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News Briefs

August 3, 2020

✦ Recognizing that many people — especially seniors — haven’t been comfortable leaving home for routine health care services, Humana Inc. said on July 23 that it’s planning to mail more than 1 million in-home preventive care screening tests to members. The initiative, which will run from June to September and triple the number of in-home screening tests Humana sends to members, will focus “particularly on members in need of colorectal cancer screening and diabetic condition management,” the insurer said. Medicare Advantage members will receive the tests for free, while eligible Medicaid members will receive the diabetic management test kits only.

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News Briefs

August 1, 2020

✦ A magistrate judge recommended dismissing a lawsuit filed by Catalyst Pharmaceuticals, Inc. against the FDA, HHS and Jacobus Pharmaceutical Company, Inc. Catalyst filed the suit (Case No. 1:19-cv-22425-BB) last year over the FDA’s approval of Jacobus’ Ruzurgi (amifampridine) for the treatment of Lambert-Eaton myasthenic syndrome in patients aged 6 years old to 17 (RSP 5/19, p. 8) less than six months after the agency approved Catalyst’s Firdapse (amifampridine) for LEMS in adults, an indication for which the company had orphan drug designation (RSP 12/18, p. 6). Catalyst contends that the FDA approval of Ruzurgi was tied to Firdapse’s $375,000 annual cost, which came under fire from Sen. Bernie Sanders (I-Vt.) last year (RSP 2/19, p. 12). Prior to Firdapse’s approval, Jacobus offered amifampridine for free through a compassionate use program. View the recommendation at http://freepdfhosting.com/14470b13c3.pdf.

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News Briefs

July 27, 2020

✦ As of March 15, 10.7 million people had effectuated coverage in the Affordable Care Act exchanges, according to new data released by CMS on July 23. Total effectuated enrollment — encompassing people who selected a plan, paid their first month’s premium, if applicable, and had coverage in February 2020 — increased by about 1% compared with total effectuated enrollment for February 2019.

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News Briefs

July 23, 2020

✦ Blue Cross and Blue Shield of North Carolina is offering certain customers up to a 33% discount on their copays for 90-day orders of maintenance medications. The policy, which became effective July 15, applies to the Blues plan’s fully insured commercial customers. “By reducing how much members pay for their 90-day prescription supply, we hope we can make things a little easier for members in addition to helping them stay home to reduce the spread of COVID-19,” said Rahul Rajkumar, M.D., chief medical officer for the insurer. Read more at https://bit.ly/2CTUSe4.

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