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Highmark to Affiliate With Largest Insurer in Western New York

June 26, 2020

Highmark Inc. on June 16 said it plans to affiliate with HealthNow New York Inc. Combined, the two health insurers would cover more than 4.4 million enrollees, according to AIS’s Directory of Health Plans. Highmark has a strong presence in Pennsylvania, Delaware and West Virginia, and if approved, this deal will expand its footprint in New York. HealthNow New York’s plans comprise 6.97% of the state’s commercial risk market, with over 0.31 million enrollees.

by Jinghong Chen

Highmark Inc. on June 16 said it plans to affiliate with HealthNow New York Inc. Combined, the two health insurers would cover more than 4.4 million enrollees, according to AIS’s Directory of Health Plans. Highmark has a strong presence in Pennsylvania, Delaware and West Virginia, and if approved, this deal will expand its footprint in New York. HealthNow New York’s plans comprise 6.97% of the state’s commercial risk market, with over 0.31 million enrollees.

Health Insurers Could See Net Gain From COVID-19 Pandemic

June 19, 2020

The estimated costs for treating COVID-19 could range from $60.2 billion to $182.2 billion over 2020 and 2021 combined, under a baseline risk scenario with a U.S. infection rate of 20%, according to an updated analysis prepared by Wakely Consulting Group on behalf of America’s Health Insurance Plans. The actuarial firm reduced the assumed rates of hospitalization and raised the estimated cost of a hospital admission based on new COVID-19 costs and utilization data. Factoring in the effect of care deferred by patients due to the pandemic, Wakely estimated that the net cost of COVID-19, under a 20% infection-rate scenario, would be -$71.0 billion to $13.8 billion for 2020 and 2021 combined.

by Jinghong Chen

The estimated costs for treating COVID-19 could range from $60.2 billion to $182.2 billion over 2020 and 2021 combined, under a baseline risk scenario with a U.S. infection rate of 20%, according to an updated analysis prepared by Wakely Consulting Group on behalf of America’s Health Insurance Plans. The actuarial firm reduced the assumed rates of hospitalization and raised the estimated cost of a hospital admission based on new COVID-19 costs and utilization data. Factoring in the effect of care deferred by patients due to the pandemic, Wakely estimated that the net cost of COVID-19, under a 20% infection-rate scenario, would be -$71.0 billion to $13.8 billion for 2020 and 2021 combined.

SOURCE: “COVID-19 Cost Scenario Modeling: Treatment, Estimating the Cost of COVID-19 Treatment for U.S. Private Insurer Providers,” America’s Health Insurance Plans. Visit https://bit.ly/2MJDoCI.

Current Market Access to Key Insulins That Will Be Featured in Part D Senior Savings Model

June 12, 2020

Medicare enrollees this fall will be able to sign up for prescription plans that cap copayments for insulin at $35 a month. Sixty insulins of various types are included in the Part D Senior Savings Model, and over 1,750 stand-alone Part D plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the demonstration for the 2021 plan year. As of May 2020, only long-acting and combination insulins were available to more than half of covered lives through preferred tier/preferred with prior authorization or step therapy status. The graphics below show how different types of insulins are covered among Medicare plans.

by Jinghong Chen

Medicare enrollees this fall will be able to sign up for prescription plans that cap copayments for insulin at $35 a month. Sixty insulins of various types are included in the Part D Senior Savings Model, and over 1,750 stand-alone Part D plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the demonstration for the 2021 plan year. As of May 2020, only long-acting and combination insulins were available to more than half of covered lives through preferred tier/preferred with prior authorization or step therapy status. The graphics below show how different types of insulins are covered among Medicare plans.

NOTES: The number of total covered lives under Medicare formularies is 46.4 million. Rapid-acting insulins include Admelog U-100, Apidra, Apidra SoloStar, Fiasp, Fiasp FlexTouch, Humalog, Humalog Junior KwikPen, Humalog KwikPen, Novolog, Novolog FlexPen and Novolog Penfill. Short-acting insulins include Humulin R, Humulin R U-500, Novolin R and Novolin R FlexPen. Intermediate-acting insulins include Humulin N, Humulin N KwikPen, Novolin N and Novolin N FlexPen. Long-acting insulins include Lantus, Levemir, Toujeo, Toujeo Max SoloStar and Tresiba. Mix insulins include Humalog Mix 50-50, Humalog Mix 75-25, Novolin 70/30 and Novolog Mix 70-30. Combination insulins include Soliqua and Xultophy.

SOURCE: Managed Markets Insight & Technology, LLC database as of May 2020.

CVS Reports Lowest Drug Trend in Years

June 5, 2020

CVS Health Corp.’s 2019 drug trend report shows a 1.4% overall trend, the lowest in five years, and said 41% of its commercial clients saw negative trend. Specialty drugs accounted for almost half of all spending and remained the fastest growing spending category in the pharmacy benefit. Autoimmune treatments, including some of the highest volume medications — Humira, Enbrel, Rituxan and Remicade — comprised a third of specialty pharmacy spending. CVS’s Advanced Control Specialty Formulary (ACSF) helped its clients reach -9.4% price growth in the category. As 20 biosimilars are expected to come to the specialty marketplace by 2023, payers may see significant savings, according to CVS.

by Jinghong Chen

CVS Health Corp.’s 2019 drug trend report shows a 1.4% overall trend, the lowest in five years, and said 41% of its commercial clients saw negative trend. Specialty drugs accounted for almost half of all spending and remained the fastest growing spending category in the pharmacy benefit. Autoimmune treatments, including some of the highest volume medications — Humira, Enbrel, Rituxan and Remicade — comprised a third of specialty pharmacy spending. CVS’s Advanced Control Specialty Formulary (ACSF) helped its clients reach -9.4% price growth in the category. As 20 biosimilars are expected to come to the specialty marketplace by 2023, payers may see significant savings, according to CVS.

NOTE: CVS’s specialty generics utilization data represents results for commercial clients.

SOURCE: CVS Health 2019 Drug Trend Report. Visit https://bit.ly/36xHZks.

Five Largest Payers See Nearly Three-Quarters of All OEP Membership Gains

May 29, 2020

Medicare Advantage enrollment grew by about 484,000 lives during the Open Enrollment Period (OEP), according to CMS’s April data release. As in the Annual Election Period (AEP), OEP gains were heavily concentrated among the five largest MA insurers (UnitedHealthcare, Humana Inc., CVS Health Corp.’s Aetna, Anthem, Inc. and Kaiser Foundation Health Plan’s California subsidiary), which saw 71.8% of the overall membership growth during the OEP. But smaller plans also made headway, with some performing nearly as well in the OEP as they did in the AEP. Three plans that saw membership losses during the AEP (Kaiser’s mid-Atlantic subsidiary, Blue Cross Blue Shield of Arizona and InnovaCare Health Solutions) were able to improve their performance in the OEP. See the top 20 OEP performers, plus their AEP results below.

by Carina Belles

Medicare Advantage enrollment grew by about 484,000 lives during the Open Enrollment Period (OEP), according to CMS’s April data release. As in the Annual Election Period (AEP), OEP gains were heavily concentrated among the five largest MA insurers (UnitedHealthcare, Humana Inc., CVS Health Corp.’s Aetna, Anthem, Inc. and Kaiser Foundation Health Plan’s California subsidiary), which saw 71.8% of the overall membership growth during the OEP. But smaller plans also made headway, with some performing nearly as well in the OEP as they did in the AEP. Three plans that saw membership losses during the AEP (Kaiser’s mid-Atlantic subsidiary, Blue Cross Blue Shield of Arizona and InnovaCare Health Solutions) were able to improve their performance in the OEP. See the top 20 OEP performers, plus their AEP results below.

*NOTE: Brand New Day’s acquisition by Bright Health was finalized May 1, 2020.

SOURCE: DHP, AIS’s Directory of Health Plans