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Trends That Matter for 2020 Star Quality Ratings

Posted by Lauren Flynn Kelly on Nov 21, 2019

According to CMS's recent release of the 2020 star quality ratings, many Medicare Advantage beneficiaries continue to enroll in plans with 4 or more stars. There was also a notable shift of membership into highly rated Prescription Drug Plans, some of which made meaningful improvements on an individual basis even though PDP performance on average was stagnant, AIS Health reported.

More than half of Medicare Advantage Prescription Drug plans (210 contracts) that will be offered in 2020 earned overall star ratings of 4 or higher, compared with 46% of MA-PDs (172 contracts) offered in 2019, CMS reported on Oct. 11. Weighted by enrollment, approximately 81% of MA-PD enrollees are currently in contracts that will have 4 or more stars in 2020, up from about 75% in 2019.
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: 'Breakthrough' Cystic Fibrosis Drug Could See High Demand

Posted by Judy Packer Tursman on Nov 14, 2019

The FDA recently approved a drug therapy for cystic fibrosis (CF) that is being viewed as a "game-changer" for the roughly nine in 10 patients with the rare, progressive disease who might benefit from it. Where does this leave payers facing rising specialty drug costs across the board? Industry experts predict that most payers likely will cover this latest cystic fibrosis treatment option despite an annual price tag topping $300,000, AIS Health reported.

Vertex Pharmaceuticals, Inc.'s Trikafta (elexacaftor/tezacaftor/ivacaftor and ivacaftor), taken as a twice-daily pill regimen, is the first triple combination therapy available to treat patients with the most common cystic fibrosis mutation. The drug directly addresses the underlying cause of the illness — mutations in the CFTR protein.

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

Radar On Market Access: Analysts Question Issues Surrounding Beovu's Uptake in Full Anti-VEGF Market

Posted by Angela Maas on Nov 12, 2019

Last month, the FDA approved Beovu (brolucizumab-dbll) from Novartis Pharmaceuticals Corp. for the treatment of neovascular (wet) age-related macular degeneration (AMD). The intravitreal injection will compete in a fairly crowded anti-vascular endothelial growth factor (anti-VEGF) market that is led by Eylea (aflibercept) from Regeneron Pharmaceuticals, Inc., AIS Health reported.

Novartis priced Beovu at $1,850 per vial — the same per-dose price as Eylea. Following three initial monthly doses, Beovu can be administered every eight to 12 weeks. Eylea also has three initial monthly doses and then may be administered every four, eight or 12 weeks.

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

Trends That Matter for IL-17 Use in Psoriasis

Posted by Angela Maas on Nov 7, 2019

For many years, the psoriasis treatment landscape was dominated by tumor necrosis factor (TNF) inhibitors. But with the FDA's approval of three interleukin-17 (IL-17) inhibitors — as well as other drugs with different mechanisms of action — for the condition, those therapies are becoming more common among treatment regimens, AIS Health reported.

The first IL-17 inhibitor on the U.S. market was Cosentyx (secukinumab) from Novartis Pharmaceuticals Corp., which launched in 2015. The next therapy was Taltz (ixekizumab) from Eli Lilly and Co., and then on Feb. 15, 2017, the agency approved Siliq (brodalumab) from Ortho Dermatologics.
 
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Topics: Industry Trends, Data & Analytics

Trends That Matter for Parkinson's Disease Medications

Posted by Jane Anderson on Oct 24, 2019

Although three new drugs for Parkinson's disease have been approved over the last year, plans generally are sticking with the drugs they've included on formularies for several years, most of which are generic, experts tell AIS Health.

That may change in the long term as new gene therapies that currently are in development are approved and come online. But none of those potential new treatments are close to market right now, says Mesfin Tegenu, R.Ph., president of PerformRx.
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: Low-Cost Enhanced PDP Offerings See Growth in 2020

Posted by Leslie Small on Oct 24, 2019

When it comes to Medicare Part D stand-alone Prescription Drug Plans (PDPs) in 2020, experts say the most notable trend is the rising prevalence of lower-cost enhanced plan offerings, AIS Health reported.

According to CMS's recently released landscape files, there will be a total of 1,433 PDP plans in 2020, up from 1,369 in 2019.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: More Than 80% of Medicare Advantage Enrollees Are in High Star Plans, CMS Reports

Posted by Lauren Flynn Kelly on Oct 22, 2019

According to CMS's recent release of the 2020 star quality ratings, many Medicare Advantage beneficiaries continue to enroll in plans with 4 or more stars. There was also a notable shift of membership into highly rated Prescription Drug Plans, some of which made meaningful improvements on an individual basis even though PDP performance on average was stagnant, AIS Health reported.

More than half of Medicare Advantage Prescription Drug plans (210 contracts) that will be offered in 2020 earned overall star ratings of 4 or higher, compared with 46% of MA-PDs (172 contracts) offered in 2019, CMS reported on Oct. 11. Weighted by enrollment, approximately 81% of MA-PD enrollees are currently in contracts that will have 4 or more stars in 2020, up from about 75% in 2019.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Trends That Matter for AML Therapy Class

Posted by Angela Maas on Oct 10, 2019

The FDA has approved nearly 10 therapies for acute myeloid leukemia (AML) over the past couple of years. Because most of them target a specific biomarker, it's critical that people diagnosed with the condition undergo genetic testing to determine whether they fall into a particular patient subgroup, AIS Health reported.

"Prior to two years ago, we had no new drugs for over a decade, and now we have eight new drugs approved in just the last two years, so the whole field has changed," said Daniel J. DeAngelo, M.D., Ph.D., chief, division of leukemia, institute physician, professor of medicine, Harvard Medical School, in an interview published on the website obroncology.com.
 
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Topics: Industry Trends, Data & Analytics

Radar On Market Access: CMS Projects Record-High Medicare Advantage Enrollment in 2020

Posted by Lauren Flynn Kelly on Oct 8, 2019

2020 is shaping up to be another competitive year for the Medicare Advantage program, which will feature an additional 600 plan choices and a continued decline in the average monthly premium, AIS Health reported. With its annual release of the so-called landscape files for the MA and Part D programs, CMS on Sept. 24 said it expects MA enrollment to reach an all-time high of 24.4 million in 2020, up 10% from the current enrollment of 22.2 million.

For 2020, the average monthly MA plan premium will drop by 14% to an estimated $23, the lowest average monthly premium since 2007. As the Affordable Care Act health insurer fee (HIF) returns in 2020, CMS's bullish enrollment outlook "indicates most plans are prioritizing stability of benefits and enrollment," observed securities analyst Michael Newshel in a Sept. 24 research note from Evercore ISI.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: Does New Medicare Plan Finder Make Part D Plans Tougher to Parse?

Posted by Leslie Small on Oct 1, 2019

Some Medicare experts are expressing concern and frustration about changes to the Medicare Plan Finder that may make it more difficult for beneficiaries to find the best Part D plan for their unique circumstances, AIS Health reported.

For example, the version of the new plan finder that CMS debuted does not include the ability to sort Part D plans based on a beneficiary's total out-of-pocket drug costs (including plan premium) for the rest of the year, says Ann Kayrish, who is the National Council on Aging’s senior program manager for Medicare.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer