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Leslie Small

Recent Posts

Trends That Matter for CAR-T Therapies

Posted by Leslie Small on Oct 22, 2020

This summer, a drug called Tecartus (brexucabtagene autoleucel) became the third chimeric antigen receptor T-cell (CAR-T) therapy approved by the FDA. CAR-T therapies, which use a patient's genetically modified immune cells to target and fight cancer cells, are a cutting-edge type of treatment that comes with eye-popping price tags, ranging from $373,000 to $475,000. However, a new report from OptumRx highlights an "industry trend to watch" that could eventually provide some relief to payers worried about how to finance CAR-T treatments, AIS Health reported.

Currently, CAR-T therapies' high cost is at least in part attributable to the "labor-intensive and time-consuming" manufacturing process for such drugs, stated the UnitedHealth Group-owned PBM's Drug Pipeline Insights Report for the third quarter of 2020. Essentially, T-cells are taken from a patient, treated and multiplied in a lab, and reinfused into the same patient — a completely personalized process known as autologous therapy.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: If Preexisting Condition Protections Vanish, Health Insurers Probably Won't Cheer

Posted by Leslie Small on Oct 6, 2020

Since at least the 2017 saga when Republicans tried to repeal and replace the Affordable Care Act (ACA), one of the law’s most visible — and politically charged — components has become its protections for people with preexisting conditions. Now, with the makeup of the Supreme Court slated to shift, some experts believe those same provisions are the most at risk from being struck down alongside the law's now-defunct individual mandate, AIS Health reported.

But that begs the question: Would health insurers actually want to go back to a pre-ACA world?

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Topics: Industry Trends, Payer

Radar On Market Access: New Manufacturing Approach May Drive Down CAR-T Therapies' Prices

Posted by Leslie Small on Oct 1, 2020

This summer, a drug called Tecartus (brexucabtagene autoleucel) became the third chimeric antigen receptor T-cell (CAR-T) therapy approved by the FDA. CAR-T therapies, which use a patient's genetically modified immune cells to target and fight cancer cells, are a cutting-edge type of treatment that comes with eye-popping price tags, ranging from $373,000 to $475,000. However, a new report from OptumRx highlights an "industry trend to watch" that could eventually provide some relief to payers worried about how to finance CAR-T treatments, AIS Health reported.

Currently, CAR-T therapies' high cost is at least in part attributable to the "labor-intensive and time-consuming" manufacturing process for such drugs, stated the UnitedHealth Group-owned PBM's Drug Pipeline Insights Report for the third quarter of 2020. Essentially, T-cells are taken from a patient, treated and multiplied in a lab, and reinfused into the same patient — a completely personalized process known as autologous therapy.

Read More

Topics: Market Access, Data & Analytics, Provider, Payer

Radar On Market Access: Experts Remain Skeptical That SCOTUS Will Scuttle Entire ACA

Posted by Leslie Small on Sep 29, 2020

The Sept. 18 death of Justice Ruth Bader Ginsburg — which could tip the scales in favor of striking down the Affordable Care Act (ACA) — was hardly welcome news for health insurers during a year when a pandemic and a presidential election are already fueling high levels of uncertainty. However, industry analysts and legal experts say there are plenty of reasons not to hit the panic button just yet, AIS Health reported.

"This definitely increases the chance of the Supreme Court striking down the full ACA. But we're going from a pretty low likelihood base," says Chris Sloan at Avalere Health. "The odds are still really stacked against anything materially changing for the ACA."

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Topics: Industry Trends, Payer

Trends That Matter for COVID Cost-Sharing Waivers

Posted by Leslie Small on Sep 24, 2020

Although federal relief legislation tied to the pandemic required health insurers to waive cost sharing for COVID-19 testing, not treatment, many plans opted to do both anyway. In fact, a recent analysis from the Kaiser Family Foundation (KFF) found that 80% of enrollees in the individual and fully insured group insurance markets were in plans that voluntarily waived out-of-pocket costs for COVID-19 at some point during the pandemic, AIS Health reported.

Yet according to the Peterson-KFF Health System Tracker analysis, published Aug. 20, 20% of individual and fully insured group plan enrollees are in plans where a cost-sharing waiver for COVID-19 treatment has already expired, and another 16% are in plans where the waiver is scheduled to expire by the end of September.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Pandemic, Market Stability Encourage Major Insurers to Expand ACA Footprints

Posted by Leslie Small on Sep 24, 2020

Given that enrollment in the Affordable Care Act (ACA) exchanges has basically flatlined, one might not expect insurers to view the exchanges as a growth opportunity. But recent moves by some of the country's largest payers suggest otherwise.

Centene Corp. said on Sept. 11 that it will widen its ACA marketplace footprint by selling plans in "nearly 400 new counties" next year. The company will increase its presence in 13 of the states where it already sells plans, plus enter two new states: Michigan and New Mexico.

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Topics: Industry Trends, Data & Analytics, Payer

Perspectives on PBM Performance Amid COVID-19

Posted by Leslie Small on Sep 17, 2020

For PBMs, 2020 has been far from business as usual, given the myriad ways the COVID-19 pandemic has changed how people interact with the health care system. However, during their second-quarter earnings conference calls, companies that own some of the largest PBMs emphasized that they are largely satisfied with how the PBM segments of their businesses are performing, AIS Health reported.

Anthem, Inc. Chief Financial Officer John Gallina said during the insurer's earnings call that "IngenioRx is actually doing quite well, and has really done a nice job of meeting our expectations."
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: Prime Therapeutics Introduces Real Time Benefit Tool

Posted by Leslie Small on Sep 17, 2020

With the deadline approaching for Medicare Part D plans to implement a Real Time Benefit Tool (RTBT) — which informs prescribers when lower-cost alternative therapies are available under a beneficiary's drug benefit — Prime Therapeutics, LLC said on Sept. 2 that it is rolling out a tool that will meet the new requirements, AIS Health reported.

In addition to showing a drug's price, the Real Time Benefit Check tool displays lower-cost and therapeutically equivalent alternatives to any given drug, breaks down costs based on a member's health plan formulary, and alerts a prescriber if a drug requires prior authorization.

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Topics: Data & Analytics, Provider, Payer

Trends That Matter for Large Employers in 2021

Posted by Leslie Small on Sep 10, 2020

While the COVID-19 pandemic has not caused employers to significantly alter their health care cost estimates for the coming year, it has unquestionably intensified their interest in embracing virtual care. Those are just a couple of the major findings from the Business Group on Health's 2021 Large Employers' Health Care Strategy and Plan Design Survey, AIS Health reported.

Notably, 80% of respondents said they believe virtual health will play a significant role in how care is delivered in the future, up considerably from 64% last year. Further, when asked about actions they were taking to ease the burdens of COVID-19 for employees, the largest share of respondents — 76% — said they "made changes to allow for better access to virtual care solutions."
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Some COVID Cost-Sharing Waivers Would Expire Soon

Posted by Leslie Small on Sep 8, 2020

Although federal relief legislation tied to the pandemic required health insurers to waive cost sharing for COVID-19 testing, not treatment, many plans opted to do both anyway. In fact, a recent analysis from the Kaiser Family Foundation (KFF) found that 80% of enrollees in the individual and fully insured group insurance markets were in plans that voluntarily waived out-of-pocket costs for COVID-19 at some point during the pandemic, AIS Health reported.

Yet according to the Peterson-KFF Health System Tracker analysis, published Aug. 20, 20% of individual and fully insured group plan enrollees are in plans where a cost-sharing waiver for COVID-19 treatment has already expired, and another 16% are in plans where the waiver is scheduled to expire by the end of September.

Read More

Topics: Industry Trends, Market Access, Data & Analytics, Payer