October

Choices, Competition Abound in 2022 ACA Exchange Market

Infographic: Insurers Made Modest ACA Rate Changes for 2022

October 29, 2021

When the annual open enrollment period for Affordable Care Act exchange plans kicks off on Nov. 1, consumers will be shopping in a market that is experiencing a surge of insurer competition and consequently, a dizzying array of plan choices.

“The number of plans that people are seeing is increasing dramatically,” David Anderson tells AIS Health, a division of MMIT. Anderson is a research associate at the Duke-Margolis Center for Health Policy who studies the ACA marketplaces.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Tech Firms Strike Revenue Management Deals With Insurers

October 29, 2021

Humana Inc. and Blue Shield of California recently became the latest payers to ink deals with prior authorization (PA) and billing tech vendors, following a national trend. Experts tell AIS Health that such deals by insurers are key to managing utilization and spending; improving patients’ and providers’ experiences; and complying with federal mandates for interoperability, price transparency and cost estimation — and could be a strategic differentiator for proactive carriers.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Centene Touts Strong Medicare, Medicaid Performance in 3Q

October 29, 2021

Centene Corp. reported solid results for the third quarter of 2021, achieving Medicare and Medicaid membership increases and raising revenue guidance for the full year. To Jefferies analyst David Windley, the company’s results “reflect an improvement from a messy 2Q.”

COVID-19-related costs, a headwind called out in Centene’s second-quarter earnings call, peaked in August. Their decline continued in October. “Similar to peers, [Centene’s management] noted an offset dynamic between rising COVID costs and declining non-COVID utilization due to Delta,” Windley noted. Centene was able to manage through this challenge with steady Medicaid and Medicare performance.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

News Briefs

October 29, 2021

The Biden administration released a diminished version of its proposed spending package, and several health care policies coveted by progressive Democrats — including drug price reform — are among the items that got cut. Critically, Medicare drug price negotiation is not included in the so-called “Build Back Better framework.” However, House Speaker Nancy Pelosi (D-Calif.) reportedly was working on a last-ditch effort to include some drug-pricing provisions. The package would extend the expanded tax credits for Affordable Care Act exchange premiums, made available during the pandemic, to 2025, and Medicare would be expanded to include hearing benefits, but would not include vision or dental.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

The Biden administration released a diminished version of its proposed spending package, and several health care policies coveted by progressive Democrats — including drug price reform — are among the items that got cut. Critically, Medicare drug price negotiation is not included in the so-called “Build Back Better framework.” However, House Speaker Nancy Pelosi (D-Calif.) reportedly was working on a last-ditch effort to include some drug-pricing provisions. The package would extend the expanded tax credits for Affordable Care Act exchange premiums, made available during the pandemic, to 2025, and Medicare would be expanded to include hearing benefits, but would not include vision or dental.
To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Will Two New PBM Startups Deliver Savings, Transparency?

October 28, 2021

Two new PBMs entered the game in recent weeks: EmsanaRx, a not-for-profit venture owned by the Purchaser Business Group on Health (PBGH), and CostPlus PBM, a startup funded by venture capitalist and Dallas Mavericks owner Mark Cuban as part of his larger foray into the pharmaceutical business. Like other recent PBM startups, both ventures claim they will be more transparent and client-focused than the Big Three PBMs (Cigna Corp.’s Express Scripts, CVS Health Corp.’s Caremark and UnitedHealth Group’s OptumRx) — but health care insiders say those promises are hard to keep.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Savings From Interchangeable Biosimilars May Be Muted

Infographic: Current Market Access to Lantus, Basaglar

October 28, 2021

The month of October brought two important developments for interchangeable biosimilars, which industry observers have long hoped will help increase uptake of lower-cost versions of complex biologic drugs.

On Oct. 15, the FDA approved Cyltezo, the first interchangeable biosimilar version of blockbuster autoimmune condition treatment Humira. And on Oct. 20, Cigna Corp.-owned Express Scripts revealed that it will now prefer Semglee — the first FDA-approved interchangeable biosimilar on the U.S. market — over the branded long-acting insulin Lantus on the PBM’s largest formulary.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.