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Zolgensma Adds Insurer Coverage Amid FDA Spanking

August 12, 2019

Novartis says its new gene therapy Zolgensma (onasemnogene abeparvovec- xioi) has coverage policies from payers representing 40% of commercial lives, and high profile news reports name Aetna Inc. and Anthem, Inc. among insurers expanding their policies to cover more patients. That’s despite a $2.125 million price tag and a mere two months on the market — and comes amid a harsh rebuke from the FDA over news that Novartis subsidiary AveXis, Inc. hid some data during the agency’s review process.

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Insurers Strive to Help Smokers Snuff Out Their Addiction

August 12, 2019

Recent research from the Centers for Disease Control and Prevention indicates that the percentage of Americans trying to quit smoking has leveled off in recent years, with most states experiencing no change in quit-attempt prevalence from 2011 to 2017. States have an opportunity to further increase the prevalence of quit-attempts, the study said, by implementing more proven interventions — such as “barrier-free access to cessation treatments.”

The Affordable Care Act, Medicare and Medicaid programs, and other federal regulations already require health plans of various types to cover a range of smoking-cessation treatments and support, and in some cases, remove barriers like prior authorization. But some insurers are opting to offer more robust tobacco-cessation programs to members — and they emphasize that such programs ought to be part of an overall wellness strategy.

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Evolent-Passport Deal Puts Kentucky MCO on ‘Path Forward’

August 12, 2019

Kentucky’s Passport Health Plan, which warned earlier this year that it was on the brink of insolvency, tells AIS Health it is “on a path forward,” now that a deal with Evolent Health has been approved by the state. It’s also dropped a lawsuit against the state and will move forward with stalled construction.

For-profit Evolent, headquartered in Arlington, Va., provides health care delivery and payment solutions and has worked with the non-profit community-based health plan since 2016. Evolent agreed to buy a 70% stake in Passport for $70 million.

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Early Rate Filings Show Modest ACA Premium Increases for 2020

August 12, 2019

by Jinghong Chen Early individual market premium rate filings for 2020 show relatively modest increases across the nation. Charts below detail the proposed year-over-year rate changes in 24 states in alphabetical order. Colorado is the only state where all insurers proposed double-digit decreases for 2020. Both Alaska and Delaware have only one insurer participating in […]

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News Briefs

August 12, 2019

✦ The Louisiana Dept. of Health unveiled the winners of its managed Medicaid contract awards on Aug. 5, selecting AmeriHealth Caritas Louisiana, Community Care Health Plan of Louisiana (Healthy Blue), Humana Health Benefit Plan of Louisiana and United Healthcare Community Plan. Incumbents Centene Corp. and CVS Health Corp./Aetna were not awarded contracts — a “surprising loss” for Centene — while the addition of Humana was a “nice win” for the firm, Citi analyst Ralph Giacobbe advised investors. For Humana, “the win is incremental to earnings (1-2%) but more importantly speaks to its ability to win organically, perhaps without the need for acquisition in the Medicaid space,” he wrote. The new contracts are effective January 2020.

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