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Leslie Small

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Radar On Market Access: 1.7K Plans Apply for Trump Admin's Fixed-Insulin-Copay Program for Seniors

Posted by Leslie Small on Jun 4, 2020

The Trump administration on May 26 shared new details about a program that offers diabetic seniors access to a variety of insulin products for a maximum $35-per-month copay, AIS Health reported.

More than 88 health insurers offering about 1,750 standalone Medicare Part D Prescription Drug Plans and Medicare Advantage plans with prescription drug coverage have now applied to participate in the Part D Senior Savings Model, which CMS unveiled in mid-March. Medicare beneficiaries in all 50 states, the District of Columbia and Puerto Rico will be able to enroll in a participating plan during the Medicare open enrollment period that lasts from Oct. 15 to Dec. 7, 2020, for Part D coverage that begins on Jan. 1, 2021.

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Perspectives on Surge of Mental Health Meds Use Amid COVID-19

Posted by Leslie Small on May 28, 2020

Newly released data from Express Scripts shows that the number of prescriptions filled per week for antidepressants, anti-anxiety and anti-insomnia medications combined jumped 21% between mid-February and mid-March — reaching a zenith during the week ending March 15, when the COVID-19 outbreak officially reached pandemic status. And analytics from UnitedHealth Group's OptumRx showed prescription increases of 15% for anti-anxiety medications, 14% for antidepressants and 5% for anti-insomnia medications during the month of March.

Industry consultants tell AIS Health that they're not at all surprised that the use of such medications is spiking. And they say that situation creates an urgent opportunity for companies that combine a health insurer with a PBM — like Express Scripts parent company Cigna Corp. and its peers — to leverage their unique insights into members' health.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: Will COVID-19 Advance Automatic Health Insurance Enrollment?

Posted by Leslie Small on May 28, 2020

As the COVID-19 pandemic continues to ravage the U.S. economy, it would seem to be the perfect time for policymakers to explore a policy option that has garnered rare bipartisan support: automatic health insurance enrollment.

"We have huge numbers of people who are losing employer-based coverage; most of them are eligible for some kind of help, but we know historically most laid-off workers do not enroll in coverage for which they qualify," Stan Dorn, director of the National Center for Coverage Innovation and senior fellow at Families USA, told AIS Health. "It's just overwhelming to be grappling with job loss and therefore it becomes imperative to make enrollment as easy, seamless and automatic as possible."

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: COVID-19 May Drive More Insurers Into ACA Exchanges

Posted by Leslie Small on May 14, 2020

As the impact of the COVID-19 pandemic continues to reverberate throughout the U.S. economy, it's become clear that there will be a major enrollment shift away from employer-sponsored plans and into Medicaid and the individual market, AIS Health reported.

In fact, one recent analysis suggested that there could be "unprecedented growth" in the individual health insurance market. "The impact of COVID-19-related job losses will likely more than double the current enrollment in Individual & Marketplace plans, with the potential for the Individual market to triple in size to over 35 million in a sustained and severe economic contraction," stated the analysis from A2 Strategy Group.

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: CVS Sees COVID Testing Sites as Part of Bigger HealthHUB Strategy

Posted by Leslie Small on May 12, 2020

Since acquiring Aetna, CVS Health Corp. has touted its HealthHUB stores — which include expanded clinics, labs for health screening and space for wellness pursuits — as the linchpin of its plan to stand out among other large, diversified firms that include a health insurer. Yet as one analyst pointed out during CVS’s first-quarter 2020 earnings call on May 6, that strategy could face new challenges amid the COVID-19 pandemic when many people are reluctant to venture outside their homes.

CVS executives said that while the company is indeed seeing less foot traffic at its brick-and-mortar locations, it is still leveraging the power of having a vast retail footprint by offering testing for the new coronavirus, AIS Health reported.

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: PBMs Say Use of Mental Health Meds Surges Amid COVID-19

Posted by Leslie Small on Apr 28, 2020

Newly released data from Express Scripts shows that the number of prescriptions filled per week for antidepressants, anti-anxiety and anti-insomnia medications combined jumped 21% between mid-February and mid-March — reaching a zenith during the week ending March 15, when the COVID-19 outbreak officially reached pandemic status. And analytics from UnitedHealth Group's OptumRx showed prescription increases of 15% for anti-anxiety medications, 14% for antidepressants and 5% for anti-insomnia medications during the month of March.

Industry consultants tell AIS Health that they're not at all surprised that the use of such medications is spiking. And they say that situation creates an urgent opportunity for companies that combine a health insurer with a PBM — like Express Scripts parent company Cigna Corp. and its peers — to leverage their unique insights into members' health.

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: Insurers Are Now Required to Cover Coronavirus Antibody Testing

Posted by Leslie Small on Apr 21, 2020

With the Trump administration anxious to "reopen" the U.S. economy and ease the social-distancing measures meant to slow the spread of COVID-19, officials have pointed to antibody testing as a critical tool to accomplish those goals. To that end, the administration on April 11 issued a document clarifying that most private health plans must cover such tests, which detect antibodies against the new coronavirus found in the blood of people who have been infected and now may be immune.

"It's not exactly a surprise, [but] I don’t know that it was 100% expected," Jason Karcher, a Milliman Inc. actuary, tells AIS Health regarding the requirement. "It seems like as much a point of clarification rather than a 'hey, we're going to require something totally out of the blue.'"

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Topics: Industry Trends, Provider, Payer

Radar On Market Access: PBMs Use Dispensing Limits to Halt Hoarding of Trump-Touted Malaria Drugs

Posted by Leslie Small on Apr 14, 2020

With the death toll from COVID-19 continuing to rise in the U.S., President Donald Trump and some of his advisers have repeatedly touted the promise of anti-malarial drugs to combat the disease caused by the novel coronavirus. That enthusiasm has sparked increasing concern that the surge in demand for such drugs, hydroxychloroquine and chloroquine, is imperiling access for patients who take them to treat autoimmune conditions such as lupus and rheumatoid arthritis, AIS Health reported.

To help alleviate the issue, some major PBMs are placing utilization management controls on off-label use of hydroxychloroquine, chloroquine and other drugs with the potential to treat COVID-19.

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Topics: Market Access, Provider, Payer

Trends That Matter for Cost Impact of Coronavirus Treatment

Posted by Leslie Small on Apr 9, 2020

Though many health insurers have removed cost barriers related to testing patients for the new coronavirus that's sweeping the globe, they largely haven't pledged to waive out-of-pocket costs for severely sickened members who require hospitalization. A new analysis suggests that the cost of caring for those patients could be steep for members and health plans alike, but experts tell AIS Health it may be too early to say what that will actually mean for commercial insurance markets.

According to the analysis, from the Peterson Center on Healthcare and the Kaiser Family Foundation (KFF), the average total cost — combining employer-plan spending and patient out-of-pocket costs — for a pneumonia-related hospital stay "with major complications and comorbidities" was $20,292 in 2018. For a stay "with complications or comorbidities," the average cost was $13,767, and for patients without complications, the price tag was $9,763. Looking at out-of-pocket costs alone, the average cost for patients with major complications or comorbidities was $1,300.
 
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Topics: Industry Trends, Market Access, Data & Analytics

Radar On Market Access: Congress Could Pass Medicare Part D Reform Even Amid COVID-19 Outbreak

Posted by Leslie Small on Mar 31, 2020

With the federal government consumed by responding to the COVID-19 outbreak, the possibility of Congress passing drug-pricing legislation might seem dim. But analysts say it's very possible that something like an overhaul of the Medicare Part D benefit could still make its way into legislation that federal lawmakers pass in the coming weeks or months to address the ongoing public health crisis, AIS Health reported.

Congress' latest coronavirus-related stimulus package, which is worth more than $2 trillion, also contains provisions that would extend some Medicare and public health funding. That's important for those watching drug-price reform because, when Congress failed to include measures addressing surprise medical billing or drug pricing in the budget bill it passed in December, many expected those issues to be addressed in legislation passed by a May 22 deadline to renew certain health care “extenders.”

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Topics: Industry Trends, Provider, Payer