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Radar On Market Access: PBMs See Solid 1Q Results Despite Challenges Ahead

Posted by Jane Anderson on May 19, 2020

Major PBMs reported strong results for the first quarter of 2020 as members rushed to fill prescriptions in March ahead of the COVID-19 pandemic. However, financial analysts warn the pandemic could have unpredictable effects on PBMs' finances for the rest of 2020 and moving into 2021, AIS Health reported.

The 2021 PBM selling season could be disrupted in still-unknown ways, analysts said, and members are cutting back on routine physician visits and elective procedures, resulting in lower script volume overall.

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Topics: Data & Analytics, Provider, Payer

MMIT Reality Check on Pain Narcotic Opioid (May 2020)

Posted by Matt Breese on May 15, 2020

According to our recent payer coverage analysis for pain narcotic opioid treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT's team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

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Topics: Specialty, Market Access, Payer, Branding & Marketing

Perspectives on Coronavirus Antibody Testing

Posted by Peter Johnson on May 14, 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: 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

MMIT Reality Check on Anemia — Chronic Kidney Disease (May 2020)

Posted by Matt Breese on May 8, 2020

According to our recent payer coverage analysis for anemia treatments due to chronic kidney disease, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT's team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

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Topics: Specialty, Market Access, Payer, Branding & Marketing

Trends That Matter for Biosimilar Medications Cost Savings

Posted by Peter Johnson on May 7, 2020

Biosimilar medications can offer meaningful cost savings for payers, but market and regulatory barriers are still preventing them from realizing their full economic potential, according to a March 31 Johns Hopkins University study funded by the ERISA Industry Committee.

"We could see and empirically prove that patients…tended to be better off if they were on the biosimilar," Mariana Socal, a physician and researcher at the Johns Hopkins Bloomberg School of Public Health and one of the study's authors, tells AIS Health. "They had lower out-of-pocket costs when they were on the biosimilar."
 
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Topics: Industry Trends, Market Access, Data & Analytics

Radar On Market Access: Anthem, Cigna Brace for Recession-Induced Enrollment Shift

Posted by Jane Anderson on May 7, 2020

Anthem, Inc., and Cigna Corp. both reported slightly better-than-expected medical loss ratios (MLRs) as part of their first-quarter 2020 earnings, in part due to delays in elective procedures resulting from the COVID-19 pandemic. Both insurers also reaffirmed their overall earnings-per-share (EPS) guidance for 2020, AIS Health reported.

But the insurers warned that MLRs may tick up later this year. In addition, they predicted that the impact of COVID-19 may lead to significant shifts in enrollment, as workers who are laid off shift to Medicaid or to the Affordable Care Act exchanges.

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Topics: Data & Analytics, Provider, Payer

Radar On Market Access: Humana, Centene Maintain 2020 Earnings Outlook Amid COVID-19 Pandemic

Posted by Peter Johnson on May 5, 2020

Humana Inc. and Centene Corp. are both maintaining their 2020 earnings outlook despite the emergence of the COVID-19 pandemic and economic contraction at the end of the first quarter, AIS Health reported.

Humana's revenues increased to $18.9 billion, and it reported $5.40 in adjusted earnings per share (EPS), beating the Wall Street consensus of $4.66 adjusted EPS. Centene's first quarter revenues increased 41% year-over-year to $26 billion, and it reported an adjusted EPS of $0.86. Centene fell short of the consensus with $0.99 adjusted EPS. Both insurers affirmed their projections for the end of the year, with Humana forecasting adjusted EPS of $18.25 to $18.75 and Centene $4.56 to $4.76.

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Topics: Data & Analytics, Provider, Payer

MMIT Reality Check on Ophthalmic Anti-Inflammatory (Apr 2020)

Posted by Matt Breese on May 1, 2020

According to our recent payer coverage analysis for ophthalmic anti-inflammatory treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT's team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

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Topics: Specialty, Market Access, Payer, Branding & Marketing