News Briefs

News Briefs

February 17, 2020

✦ In public remarks made Feb. 11, CMS Administrator Seema Verma hinted at possible regulatory changes to prior authorization. Verma says CMS has received more than 2,000 comments on the subject of prior authorization, and held 35 “listening sessions” with stakeholders. On the legislative side, insurers have expressed concern about a bill that would standardize prior authorization in the Medicare Advantage program (HPW 9/30/19, p. 4).

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News Briefs

February 13, 2020

✦ CMS on Feb. 5 issued a proposed rule that would allow Medicare Part D sponsors to establish a second, “preferred” specialty drug tier with lower cost-sharing than the current specialty tier — after plan sponsors and PBMs indicated that would encourage the use of more preferred, less expensive agents. The proposed rule, which includes an array of changes to the Medicare Advantage and Part D programs for policy years 2021 and 2022, also would require each Part D plan to implement a Beneficiary Real Time Benefit Tool that lets enrollees view plan-provided, patient-specific, real-time formulary and benefit information. Visit https://go.cms.gov/38kOG9w to learn more.

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News Briefs

February 10, 2020

✦ CVS Health Corp. said on Feb. 3 that former Aetna Inc. CEO Mark Bertolini, who led the health insurer when it was acquired by the pharmacy chain, will leave the CVS board once integration is complete. But in an interview with the Wall Street Journal, Bertolini claimed he was forced out, and implied that he lost a power struggle with CVS CEO Larry Merlo. “There’s always going to be a natural tension between the current CEO and the former CEO in any discussions regarding how you move the strategy forward,” Bertolini told the publication

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News Briefs

February 6, 2020

✦ Humana Inc. on Feb. 4 said it partnered with private equity firm Welsh, Carson, Anderson & Stowe (WCAS) to expand access to value-based care for Medicare patients. Through the new joint venture, the partners will develop and operate “senior-focused, payor-agnostic, primary care centers” that will be managed by Humana’s Partners in Primary Care subsidiary and operated under the PIPC brand. WCAS is making an initial commitment of $600 million to the joint venture, in which it will have majority ownership. (The firm owns a majority stake in MMIT, AIS Health’s parent company.) Visit https://huma.na/370wr7Y.

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News Briefs

February 3, 2020

✦ On Jan. 27, the Supreme Court lifted an injunction blocking implementation of a Dept. of Homeland Security rule that makes obtaining a green card or entering the United States more difficult for legal immigrants who would otherwise qualify for federal benefits, including Medicare and Medicaid. A September 2019 Kaiser Family Foundation (KFF) report on the then-pending rule predicted that, if implemented, it could cause 2 million to 4.7 million people to disenroll from programs like CHIP and Medicaid “due to fear and confusion about the changes.” According to the report, “decreased participation in Medicaid would increase the uninsured rate among immigrant families, reducing access to care and contributing to worse health outcomes.”

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News Briefs

February 1, 2020

✦ Pfizer Inc. unveiled its launch strategy for three biosimilars. Zirabev (bevacizumab-bvzr) launched Dec. 31 at a wholesale acquisition cost (WAC) of $61.343 per 10 mg, a 23% discount to that of reference drug Avastin (bevacizumab), from Genentech USA, Inc., a member of the Roche Group. Ruxience (rituximab-pvvr) launched Jan. 23 at a WAC of $71.68 per 10 mg, a 24% discount to the WAC of reference drug Rituxan (rituximab) from Genentech and Biogen. And Trazimera (trastuzumab-qyyp) will launch Feb. 15 with a WAC of $80.74 per 10 mg, a 22% discount to that of Genentech’s Herceptin (trastuzumab). View the press release at https://bit.ly/2RV1vll.

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