Obamacare Markets Will Not Reopen, Trump Decides

April 1, 2020

The Trump administration has decided against reopening the Affordable Care Act’s Healthcare.gov marketplaces to new customers, despite broad layoffs and growing fears that people will be uninsured during the coronavirus outbreak.

The option to reopen markets, in what is known as a special enrollment period, would have made it easier for people who have recently lost jobs or who had already been uninsured to obtain health insurance. The administration has established such special enrollment periods in the past, typically in the wake of natural disasters.

The Trump administration has decided against reopening the Affordable Care Act’s Healthcare.gov marketplaces to new customers, despite broad layoffs and growing fears that people will be uninsured during the coronavirus outbreak.

The option to reopen markets, in what is known as a special enrollment period, would have made it easier for people who have recently lost jobs or who had already been uninsured to obtain health insurance. The administration has established such special enrollment periods in the past, typically in the wake of natural disasters.

The administration had been considering the action for several weeks, and President Trump mentioned such conversations in a recent news briefing. But according to a White House official, those discussions are now over. The news of the decision was previously reported by Politico….

Read the full The New York Times article

Biosimilars Could Disappear If the Supreme Court Overturns the ACA

April 1, 2020

With the sense of urgency rightly focused on slowing or stopping the spread of Covid-19, it seems like everything else in the news, and in health care, has come to a grinding halt. Yet important decision-making continues in the background, including some that could have long-lasting effects on health care today and in the future.

One of these is the decision by the U.S. Supreme Court to hear California v. Texas, a case that will decide whether most or all of the Affordable Care Act should be overturned.

With the sense of urgency rightly focused on slowing or stopping the spread of Covid-19, it seems like everything else in the news, and in health care, has come to a grinding halt. Yet important decision-making continues in the background, including some that could have long-lasting effects on health care today and in the future.

One of these is the decision by the U.S. Supreme Court to hear California v. Texas, a case that will decide whether most or all of the Affordable Care Act should be overturned.

The story of how the case got back to the Supreme Court is a long one, but there is an underdiscussed component of the ACA that the court’s decision could affect: the fate of the U.S. biosimilars market, which is key to lowering health care costs. The outcome of the cases could affect biosimilars because embedded within the ACA is the Biologics Price Competition and Innovation Act (BPCIA). This act created a regulatory pathway for biosimilar medicines and marked the beginning of a new era for biologic treatments in the United States….

Read the full Stat article

Datapoint: Roche Starts Actemra in COVID-19 Trials

April 1, 2020

The FDA last week approved Roche’s phase 3 trial of its interleukin-6 inhibitor, Actemra, in COVID-19 patients that have been hospitalized with pneumonia. The drug was already used to treat coronavirus patients in China. The drugmaker also said it has added 10,000 vials of Actemra to the Strategic National Stockpile. The intravenous form of Actemra is covered under the pharmacy benefit for 25% of insured lives, and under the medical benefit for 21% of lives. 37% of all covered lives have access to Actemra under both the pharmacy and medical benefit.

The FDA last week approved Roche’s phase 3 trial of its interleukin-6 inhibitor, Actemra, in COVID-19 patients that have been hospitalized with pneumonia. The drug was already used to treat coronavirus patients in China. The drugmaker also said it has added 10,000 vials of Actemra to the Strategic National Stockpile. The intravenous form of Actemra is covered under the pharmacy benefit for 25% of insured lives, and under the medical benefit for 21% of lives. 37% of all covered lives have access to Actemra under both the pharmacy and medical benefit.

SOURCE: MMIT Analytics, as of 3/30/20

Private Payers Aren’t Yet Sold on Vraylar for Bipolar Disorder

April 1, 2020

A recently approved brand drug for bipolar disorder will have little impact on how health plans cover these medications, experts say. Health plans will continue to encourage the use of less expensive generic bipolar drugs.

The brand drug, Allergan plc’s Vraylar (cariprazine), was approved by the FDA to treat depressive episodes associated with bipolar 1 disorder in adults. It is an oral, once-daily atypical antipsychotic.

By Bronwyn Mixter

A recently approved brand drug for bipolar disorder will have little impact on how health plans cover these medications, experts say. Health plans will continue to encourage the use of less expensive generic bipolar drugs.

The brand drug, Allergan plc’s Vraylar (cariprazine), was approved by the FDA to treat depressive episodes associated with bipolar 1 disorder in adults. It is an oral, once-daily atypical antipsychotic.

There are other medications approved to treat the same conditions as Vraylar, including generic drugs, Mesfin Tegenu, R.Ph., president of PerformRx, tells AIS Health. Vraylar is typically not a preferred option since it is a newer, branded and more expensive agent, and more cost-effective alternatives are available, he says.

However, non-formulary drugs are available to those who have a demonstrated medical need. “There can be adherence issues with this disease and at times there is a need for longer acting agents to improve adherence,” Tegenu says.

Health plans employ several utilization management techniques for bipolar drugs, according to Tegenu. Some examples include prior authorization, duplicate therapy edits, age restrictions and step therapy.

For Vraylar, health plans will use prior authorization or steps to encourage the use of a generic bipolar drug first, Michael Schneider, a principal at Avalere Health, tells AIS Health. There also could be some higher out-of-pocket costs for Vraylar even when compared to some of the other branded antipsychotic drugs.

Vraylar is in a protected drug class on the Medicare side, Schneider says. Because it is the first brand drug of a particular chemical entity, plans have to cover it. In some Medicare plans, Vraylar is disadvantaged because even through it is in a protected class, there are still utilization management techniques placed on the product, as well as higher cost sharing, he says.

In Medicaid, many states require all the antipsychotic bipolar drugs to be on the formulary with no utilization management, Schneider adds.

Datapoint: Aetna Waives Cost Sharing for COVID-19 Treatment

March 31, 2020

CVS Health Corp.’s Aetna last week said it would waive all cost sharing and copayments for inpatient coronavirus treatment. Previously, the insurer has waived coinsurance fees for coronavirus testing, and stopped requiring pre-authorization for hospitalizations in states that have been hit hard by the pandemic, such as New York and Washington. Aetna currently serves 21,333,020 members nationwide, with 33.6% enrolled in risk-based commercial products.

CVS Health Corp.’s Aetna last week said it would waive all cost sharing and copayments for inpatient coronavirus treatment. Previously, the insurer has waived coinsurance fees for coronavirus testing, and stopped requiring pre-authorization for hospitalizations in states that have been hit hard by the pandemic, such as New York and Washington. Aetna currently serves 21,333,020 members nationwide, with 33.6% enrolled in risk-based commercial products.

Source: AIS’s Directory of Health Plans