Soaring Insulin Prices Prompt Insurers to Take Action

March 18, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications.

At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D “doughnut hole.”

By Leslie Small

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications.

At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D “doughnut hole.”

One tactic that the organization’s health plan deploys to ease the burden on members is a policy called “plan pay the difference,” Fried says. If a brand drug becomes cheaper than the generic version after rebates, “we would actually have the member pay the generic copay instead of the brand, and then we would reimburse the pharmacy the brand cost, so that they’re made whole as well,” she says.

At Geisinger Health Plan, Medicare enrollees are the ones who have the most trouble paying for their insulin, according to Jamie Miller, the health plan’s system director of managed care pharmacy. Overall, Geisinger saw its spending in the diabetes drug class rise 13.8% between 2017 and 2018, she adds.

As Geisinger works out what it wants its Medicare benefit to look like in 2020, Miller says one goal is to make insulin more affordable for its senior members. Thus, the health plan is considering adding a sixth, “zero-dollar” tier to its Part D formulary where it would put insulin and select other drugs.

People on the Move

March 15, 2019

Paying Patients to Switch to Lower-Price Providers Could Pay Off

March 15, 2019

Financially rewarding members who visit lower-price providers can drive health care savings, according to a study published in the March edition of Health Affairs. The study evaluated the impact of a Health Care Service Corp. rewards program launched in January 2017 by 29 employers, which paid patients $25 to $500 for receiving care from a designated lower-price provider for certain elective services.

by Jinghong Chen

Financially rewarding members who visit lower-price providers can drive health care savings, according to a study published in the March edition of Health Affairs. The study evaluated the impact of a Health Care Service Corp. rewards program launched in January 2017 by 29 employers, which paid patients $25 to $500 for receiving care from a designated lower-price provider for certain elective services. Researchers found that the implementation of the program was associated with a 2.1% reduction in the average price per service across all eligible services, a 1.3-percentage-point increase in the probability of an employee receiving care from a lower-price provider, and a 0.26-percentage-point relative reduction in the fraction of people in the intervention population who used a reward-eligible service. MRIs, ultrasounds and mammograms saw the greatest decreases in prices.

NOTE: The graphic shows the results of a difference-in-differences analysis that compared prices, use of lower-price providers, and utilization in the first year of the rewards program (2017) versus in the two prior years (2015-16), with trends in the comparison population controlled for.

SOURCE: Health Affairs 38, No. 3 (2019): 440-447. Visit https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05068.

Datapoint: Minnesota Releases Medicaid RFP

March 14, 2019

Minnesota recently released a Request For Proposals (RFP) for the bulk of its managed Medicaid programs, as well as Senior Health Options, its demonstration program for Medicare-Medicaid dual eligibles. 851,540 Minnesotans are enrolled in Medicaid managed care plans, and the state’s Senior Health Options program currently serves 39,907 dual eligibles.

Minnesota recently released a Request For Proposals (RFP) for the bulk of its managed Medicaid programs, as well as Senior Health Options, its demonstration program for Medicare-Medicaid dual eligibles. 851,540 Minnesotans are enrolled in Medicaid managed care plans, and the state’s Senior Health Options program currently serves 39,907 dual eligibles.

Source: AIS’s Directory of Health Plans

Fallon Health Reports Solid Financial Results with Aim to Adapt and Grow

March 14, 2019

Fallon Health in Massachusetts recently reported solid fourth quarter and full-year 2018 financial results, crediting its strategic investments in government programs and careful management of expenses as helping it continue to adapt and grow in its niche as a community health plan.

Fallon is experiencing growth in its Medicare Advantage (MA) line of business, and in Medicaid has enrolled nearly 100,000 members in its accountable care organizations under a reform initiative launched by MassHealth almost exactly a year ago.

By Judy Packer-Tursman

Fallon Health in Massachusetts recently reported solid fourth quarter and full-year 2018 financial results, crediting its strategic investments in government programs and careful management of expenses as helping it continue to adapt and grow in its niche as a community health plan.

Fallon is experiencing growth in its Medicare Advantage (MA) line of business, and in Medicaid has enrolled nearly 100,000 members in its accountable care organizations under a reform initiative launched by MassHealth almost exactly a year ago.

“Strategically, that’s where we’re putting our focus as a company,” Richard Burke, Fallon’s president and CEO, says of government-sponsored programs, noting “demographic and public policy changes have…allowed us to grow in the government space.”

“It’s clear that there is and will continue to be significant growth in government health lines of business,” especially from baby boomers aging into MA and Medicaid expansion, says Ceci Connolly, president and CEO of the Alliance of Community Health Plans, of which Fallon is a member. “And while every health plan in America knows that, I think that community-based plans that have been mission-driven probably have a jump because it’s part of their portfolio and their commitment to the community.”

In Connolly’s view, community-based plans’ close collaboration with local providers results in “better outcomes, happier consumers and much better value for the health care dollar,” and such plans’ experience “puts them a little further ahead” on risk contracting with providers and drugmakers.