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Iowa Medicaid Saves $126 Million in Move to Managed Care

December 14, 2018

An Iowa state auditor concluded in a Nov. 26 report that the state’s Medicaid privatization efforts will save taxpayers an estimated $126 million this year. The audit follows a series of flip-flopping savings estimates from the state, which ranged from $47 million to $234 million. State Auditor Mary Mosiman (R) criticized the state’s failure to establish a routine method to determine savings, and noted that future savings will be difficult to estimate as the state moves further away from fee-for-service.

by Carina Belles

An Iowa state auditor concluded in a Nov. 26 report that the state’s Medicaid privatization efforts will save taxpayers an estimated $126 million this year. The audit follows a series of flip-flopping savings estimates from the state, which ranged from $47 million to $234 million. State Auditor Mary Mosiman (R) criticized the state’s failure to establish a routine method to determine savings, and noted that future savings will be difficult to estimate as the state moves further away from fee-for-service. Since the program, IA Health Link, launched in 2016, the state has moved more than 90% of its Medicaid and Children’s Health Insurance Program (CHIP) members into managed care plans (see chart below).

NOTE: Meridian Health Plan served the Iowa Medicaid population from 2012 to year-end 2015. The company applied but was not awarded a contract for IA Health Link.

SOURCE: DHP, AIS’s Directory of Health Plans; Office of Auditor of State, State of Iowa, Report on a Review of the Medicaid Savings Estimates for the Period January 1, 2017 Through November 7, 2018. Visit https://www.auditor.iowa.gov/reports/54835/reportFile/embed.

Walgreens, Humana May Expand Their Partnership

December 7, 2018

Walgreen Co. and Humana Inc. are reportedly in preliminary talks to take equity stakes in one another. This past summer, the two companies unveiled a partnership aimed at providing easier access to primary care and other services for seniors in the Kansas City, Mo., area.

Walgreen Co. and Humana Inc. are reportedly in preliminary talks to take equity stakes in one another. This past summer, the two companies unveiled a partnership aimed at providing easier access to primary care and other services for seniors in the Kansas City, Mo., area. As of Aug. 31, 2018, Walgreens owned 9,560 drugstores in total across all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. With almost 3.3 million Medicare beneficiaries, Humana holds a 17.7% market share in the Medicare Advantage (MA) market nationwide, and it dominates in Mississippi and Louisiana with more than 60% market share.

SOURCES: Walgreen Co., AIS’s Directory of Health Plans, https://aishealthdata.com/dhp.

Current Market Access to Migraine Medications

November 30, 2018

The FDA in September approved two new migraine drugs: Eli Lilly and Co.’s Emgality and Teva Pharmaceuticals’ Ajovy, which will compete with Aimovig from Amgen Inc. and Novartis AG. For most migraine medications on the market, more than half of covered lives are under the preferred tier/preferred with prior authorization or step therapy and covered tier/covered with PA/ST, as of November 2018.

by Jinghong Chen

The FDA in September approved two new migraine drugs: Eli Lilly and Co.’s Emgality and Teva Pharmaceuticals’ Ajovy, which will compete with Aimovig from Amgen Inc. and Novartis AG. For most migraine medications on the market, more than half of covered lives are under the preferred tier/preferred with prior authorization or step therapy and covered tier/covered with PA/ST, as of November 2018. The chart below shows how migraine medications are covered among commercial health plans, health exchange plans and Medicare and Medicaid programs under the pharmacy benefit.

NOTE: The number of total covered lives is 302.1 million. For Migranal, about 0.1% of covered lives are under the generic (preferred) tier.

SOURCE: Managed Markets Insight & Technology, LLC database as of November 2018.

Medicaid Expansion Passes in Idaho, Utah and Nebraska

November 16, 2018

by Jinghong Chen
Voters in three historically red states — Idaho, Utah and Nebraska — on Nov. 6 passed ballot initiatives to expand Medicaid to residents living at less than 133% of the Federal Poverty Level. To date, 36 states and Washington, D.C., have decided to expand Medicaid under the Affordable Care Act. The move could bring coverage to more than 300,000 people in the three new states combined. According to AIS’s Medicare and Medicaid Market Data,

by Jinghong Chen
Voters in three historically red states — Idaho, Utah and Nebraska — on Nov. 6 passed ballot initiatives to expand Medicaid to residents living at less than 133% of the Federal Poverty Level. To date, 36 states and Washington, D.C., have decided to expand Medicaid under the Affordable Care Act. The move could bring coverage to more than 300,000 people in the three new states combined. According to AIS’s Medicare and Medicaid Market Data, Idaho currently enrolls 277,892 Medicaid eligibles, Utah 288,874 and Nebraska 244,173, as of Oct. 17, 2018.

NOTE: Estimates of expected Medicaid enrollees assumes non-expansion states expand coverage under the Affordable Care Act in 2019 based on the 2017 American Community Survey 1-Year Public Use Microdata Sample of the individual health insurance market and uninsured populations with incomes under 138% of the federal poverty limit.

SOURCES: AIS’s Medicare and Medicaid Market Data; Avalere Health LLC and Kaiser Family Foundation.