Member: Health Plan Weekly

Payers Bet on Telemedicine to Solve Primary Care Challenges

January 27, 2020

Access to primary care is one of the crucial challenges facing the health care system. As payers and providers try to rein in specialist and acute care overuse, preventive medicine and patient education — central aspects of primary care — have become more important than ever, especially as the baby boomer generation ages into Medicare plans.

Yet a shortage of primary care physicians (PCPs) has frustrated efforts to manage care systemwide. Physician assistants and nurse practitioners have started to fill some demand, but the number of people with a PCP declined between 2002 and 2015, according to a December 2019 JAMA Internal Medicine study.

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Nebraska Applies for Two-Tiered Medicaid Expansion Waiver

January 27, 2020

With Medicaid demonstration programs that include work requirements struck down in three states, it’s become increasingly clear that such waivers may not survive legal scrutiny. So Nebraska, which last month submitted its own Section 1115 waiver application, is trying a different tactic.

In its application to CMS, the state proposes to modify voter-approved Medicaid expansion by creating two tiers of coverage: Basic, which includes “comprehensive medical, behavioral health and prescription drug coverage” as required by federal law, and Prime, which is the Basic package plus vision, dental and over-the-counter medication coverage. To access the Prime benefits, non-exempted adults must complete “certain wellness, personal responsibility and community engagement activities” such as choosing a primary care provider, regularly attending scheduled doctor appointments, and engaging in a job or volunteer work.

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CVS Health Proposes Four Ways To Cope With Gene Therapy Cost

January 27, 2020

As payers brace themselves for accelerated approvals of cell and gene therapies, they are searching for ways to manage those costs. In an effort to keep pace with competitors, CVS Health Corp. entered the fray, sketching out its strategy for delivering and covering gene therapy in the white paper “Gene Therapy, Keeping Costs From Negating Its Unprecedented Potential.”

There are 800 investigational new drug applications for cell and gene therapies, according to Sarah Butler Donovan, head of client solutions, marketing and operations at Avalere, and the FDA has had to hire 50 new reviewers that are going to be focusing on these new areas. “We’re anticipating, starting this year, roughly 10 approvals for cell and gene therapies a year,” Donovan said during a recent webinar.

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Supreme Court Declines Expedited Review of ACA Lawsuit

January 27, 2020

In a blow to the managed care industry, the Supreme Court chose to delay intervening in Texas v. United States, the Republican state attorneys general-led lawsuit that would overturn the Affordable Care Act (ACA).

“By declining to take up this case in an expedited manner, the Supreme Court leaves in place the cloud of uncertainty that hangs over the Affordable Care Act,” said Association for Community Affiliated Plans (ACAP) CEO Margaret A. Murray in a press release. “We are disappointed in the Court’s decision. Consumers will continue to pay the price for this confusion as the case stagnates, but we remain confident the ACA will withstand this challenge.”

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News Briefs

January 27, 2020

✦ Having now satisfied all necessary regulatory requirements, Centene Corp. and WellCare Health Plans, Inc. closed their $17 billion deal on Jan. 23. Centene is the country’s largest managed Medicaid insurer and the biggest player on the Affordable Care Act exchanges, and the acquisition of WellCare will increase its footprint in the Medicare Advantage market. Centene now serves more than 24 million members across all 50 states, according to a press release. With the completion of the transaction, the divestitures of Centene’s Illinois Medicaid and Medicare Advantage plans, WellCare’s Missouri Medicaid and Medicare Advantage plans and WellCare’s Nebraska Medicaid plan have also closed, the companies noted.

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