Trump’s Next Health Care Move: Giving Silicon Valley Your Medical Data

February 19, 2020

The Trump administration’s push to give patients more control over their health records could turn over a massive trove of very personal data to giant tech companies, app designers and data brokers.

The Trump administration’s push to give patients more control over their health records could turn over a massive trove of very personal data to giant tech companies, app designers and data brokers.

If proposed policy changes go through, patients would be able to download their health records on to their smartphones and direct it to apps of their choice. But there’s a major privacy pitfall: As soon as those records leave the software system of the doctor or hospital, they are no longer protected by HIPAA, the landmark medical privacy law….

Read the full article from Politico

How the Drug Lobby Lost Its Mojo in Washington

February 19, 2020

The drug industry doesn’t pack the lobbying punch it once did, and one sign is something rare in the capital today—a dose of bipartisanship.

The drug industry doesn’t pack the lobbying punch it once did, and one sign is something rare in the capital today—a dose of bipartisanship.

Sen. Chuck Grassley (R., Iowa) joined Sen. Ron Wyden (D., Ore.) to write a bill last July to regulate prescription-drug prices, an idea the industry has bottled up since the 1960s. Sen. John Cornyn (R., Texas) with Sen. Richard Blumenthal (D., Conn.) sponsored a bill in May to block drug companies from using patent laws to delay lower-priced drugs….

Read the full article from The Wall Street Journal

Datapoint: Pennsylvania Implements Medicaid Jobs Program

February 19, 2020

Pennsylvania has launched a new Medicaid initiative that helps connect enrollees to jobs and career services. New Medicaid sign-ups are asked if about their interest in “help finding a job, training programs, and opportunities to get a high school diploma or GED,” per the state’s press release. Unlike Medicaid work requirements, participation in Pennsylvania’s program is not mandatory, and does not affect Medicaid eligibility. The state currently serves 2,777,216 Medicaid beneficiaries, with 78.9% enrolled in managed care plans.

Pennsylvania has launched a new Medicaid initiative that helps connect enrollees to jobs and career services. New Medicaid sign-ups are asked if about their interest in “help finding a job, training programs, and opportunities to get a high school diploma or GED,” per the state’s press release. Unlike Medicaid work requirements, participation in Pennsylvania’s program is not mandatory, and does not affect Medicaid eligibility. The state currently serves 2,777,216 Medicaid beneficiaries, with 78.9% enrolled in managed care plans.

Source: AIS’s Directory of Health Plans

Payers Try New Strategies to Control Diabetes Drug Costs

February 19, 2020

With the cost of diabetes drugs still growing, PBMs and payers are looking for more innovative strategies to hold down costs. For some, that might include a strategy similar to the one recently unveiled by CVS Health Corp.’s Caremark unit. The plan, called RxZERO, offers a slimmer formulary for the diabetes drug class, but with no out-of-pocket costs for members.

by Lisa Gillespie

With the cost of diabetes drugs still growing, PBMs and payers are looking for more innovative strategies to hold down costs. For some, that might include a strategy similar to the one recently unveiled by CVS Health Corp.’s Caremark unit. The plan, called RxZERO, offers a slimmer formulary for the diabetes drug class, but with no out-of-pocket costs for members.

Mike Schneider, a principal in the commercialization and market access practice at Avalere Health, says the plan is innovative. “You’ve seen Express Scripts do something where they’re offering specific insulins at very low out-of-pocket costs, but this is the first time I’ve seen a PBM come up with a way to eliminate out-of-pocket costs completely,” he tells AIS Health.

With the elimination of copays and other cost-sharing payments for diabetes drugs, CVS is betting members will better adhere to drug regimens and potentially avoid unnecessary hospitalizations and other services.

But these types of plans might not work for all member populations. Marc Guieb, a pharmacy consultant at Milliman, Inc., says member satisfaction can play a part in whether a plan sponsor goes this route, or sticks to a more traditional strategy that places higher-cost drugs in a step therapy plan.

The market for diabetes drugs is tight, with a few big manufacturers that all have similar prices. But there’s one new player, Civica Rx, that’s aiming to change that. In January, 18 plans in the Blue Cross Blue Shield Association joined with Civica Rx to produce up to 10 generic drugs at low cost by 2021.

Included in the partnership is Blue Shield of California, where Alison Lum is the vice president of pharmacy services. “The way that we’ve managed [drugs] in the past probably won’t get us to be sustainably affordable in the future,” Lum says. “We have to think about new ways of doing things.”

Datapoint: Molina Expects Less Exchange Income in 2020

February 18, 2020

Molina Healthcare in its fourth quarter 2019 earnings call said it expects to receive far less income from its Affordable Care Act exchange plans in 2020. The company is currently projecting that its exchange margins will top out at 4.9% this year, compared to 10.3% in 2019, which could add up to a difference of about $75 million.

Molina Healthcare in its fourth quarter 2019 earnings call said it expects to receive far less income from its Affordable Care Act exchange plans in 2020. The company is currently projecting that its exchange margins will top out at 4.9% this year, compared to 10.3% in 2019, which could add up to a difference of about $75 million. In the earnings call, executives cited increased competition for exchange membership, resulting in fewer sign-ups than anticipated, as one of the reasons for the unexpected drop. Molina currently serves 289,410 exchange members, as of the latest update to AIS’s Directory of Health Plans, representing about 9% of its total enrollment.

Source: AIS’s Directory of Health Plans