Formulary guidance and transparency from P&T to point of care

Trends That Matter for MCO's Role in COVID Vaccine Rollout

Posted by Lauren Flynn Kelly on Jan 14, 2021

States and the federal government recently began rolling out the COVID-19 vaccine to health care workers across the country. Health plans, particularly those that serve high-risk individuals, may be ideally situated to coordinate care and update members on vaccination opportunities, experts tell AIS Health.

The FDA on Dec. 11 authorized emergency use of the COVID-19 vaccine made by Pfizer Inc. and BioNTech in individuals age 16 and older. Then the agency on Dec. 18 authorized Moderna’s vaccine for emergency use in people 18 years or older.
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Topics: Market Access, Product Release, Data & Analytics, Payer

Perspectives on New-to-Market Oral Drugs

Posted by Leslie Small on Jan 7, 2021

In its latest quarterly Drug Pipeline Insights Report, OptumRx includes a diverse array of medications that the UnitedHealth Group-owned PBM believes are likely to make a market impact when they're approved by the FDA, AIS Health reported. One interesting trend that applies to three of the five highlighted drugs is the fact that each is the first oral option in its respective category.

While oral medications tend to be thought of as more convenient than injectable or IV-administered therapies, that factor alone may not confer as much of a competitive advantage as one might think, according to one OptumRx executive.
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Topics: Industry Trends, Product Release, Data & Analytics

Trends That Matter for COVID Vaccine Distribution

Posted by Brian Eastwood on Dec 31, 2020

As details continue to emerge about the availability of COVID-19 vaccines and how they will be administered, the role that payers will play in the process is becoming clearer, AIS Health reported.

It's imperative for health plans to do two key things at the same time, according to Katherine Dallow, M.D., the vice president of clinical programs and strategy at Blue Cross Blue Shield of Massachusetts. Payers need to help the entities that will be distributing the vaccine to identify the individuals who should be first in line to be vaccinated, and they need to use their resources to help educate the community.
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Topics: Market Access, Product Release, Data & Analytics, Payer

Radar On Market Access: PBMs Continue Integration, Face More Regulatory Challenges in 2020

Posted by Peter Johnson on Dec 29, 2020

In 2020, the PBM industry continued to deepen its integration with other industry players, a trend that experts say is likely to continue in coming years. The PBM space has consolidated to the point that five firms — UnitedHealth Group's OptumRx, CVS Health Corp.'s Caremark, Cigna Corp.'s Express Scripts, Anthem Inc.'s IngenioRx, Humana Inc.'s Humana Pharmacy Solutions, and the Blue Cross and Blue Shield affiliate-owned Prime Therapeutics LLC — manage the lion's share of the pharmacy benefits offered to U.S. health plan members.

Beyond their deepening integration with the payers that own them, these firms are working to expand their data and direct-to-consumer operations, AIS Health reported.

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

Perspectives on Amazon Pharmacy

Posted by Leslie Small on Dec 24, 2020, Inc. made a splash in the health care world on Nov. 17 when the online retail powerhouse unveiled new pharmacy offerings that aim to disrupt the prescription drug market with increased convenience and savings, AIS Health reported.

In addition to setting up its own online pharmacy, Amazon is partnering with one of the three largest PBMs — Cigna Corp.'s Express Scripts — to offer a prescription-savings benefit that will be available to Amazon Prime members. "It can be used for discounts up to 80% off generic and 40% off brand name medications at over 50,000 participating pharmacies nationwide," according to a press release.
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Topics: Industry Trends, Data & Analytics, Payer

Trends That Matter: Centene's ACA Expansion

Posted by Leslie Small on Dec 17, 2020

Centene Corp., which has come to dominate the Affordable Care Act exchange market by continuing to expand even when other carriers pulled back, is facing more competition now that the market has stabilized and insurer participation has increased, AIS Health reported.

Given that dynamic, Citi analyst Ralph Giacobbe advised investors recently that he was placing a "negative catalyst watch" on Centene due to the new competitive pressures it's facing. Centene, he observed, "was displaced as the lowest priced plan in a number of markets," and so the insurer "will have to rely on retention and new market entry to offset competitive pressures, which could prove challenging and may stunt growth relative to expectations."
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Topics: Industry Trends, Data & Analytics, Payer

Trends That Matter for Growth Hormone Deficiency Treatments

Posted by Angela Maas on Dec 3, 2020

When the FDA approved Novo Nordisk, Inc.'s Sogroya (somapacitan-beco) for the replacement of growth hormone in adults with growth hormone deficiency on Aug. 28, it became the only long-acting agent on the market, AIS Health reported.

There are seven short-acting growth hormones currently available to treat adults with growth hormone deficiency, all of them branded forms of somatropin. Differences among the products, all of which are self-administered, include the strengths available and the type of device to deliver the treatment. But all of them must be administered daily. Sogroya, which also is self-administered, is the only FDA-approved product with weekly dosing.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: MA Insurers Report Strong Performance, Predict Enrollment Growth

Posted by Lauren Flynn Kelly on Dec 1, 2020

Select publicly traded insurers reporting third-quarter 2020 earnings this past month predicted big gains in Medicare Advantage enrollment during the current Annual Election Period (AEP), and noted that growth in government products helped offset the impact of commercial losses and COVID-19 costs in the recent quarter, AIS Health reported.

Reporting third-quarter 2020 earnings on Nov. 6, CVS Health Corp. said a 3.5% year-over-year increase in overall revenues was due in part to growth in its Health Care Benefits segment, which includes Aetna. Revenues in that segment rose 8.8% from the prior-year quarter to $18.7 billion, primarily driven by membership increases in Aetna's government products and the favorable impact of the return of the Affordable Care Act health insurer fee for 2020.

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Topics: Data & Analytics, Payer

Perspectives on CMS Insulin Demo

Posted by Leslie Small on Nov 26, 2020

In 2021, about half of enhanced stand-alone Prescription Drug Plans (PDPs) and a little more than a third of Medicare Advantage-Prescription Drug (MA-PD) plans will participate in a new demonstration that aims to lower diabetic seniors' out-of-pocket costs by capping copays at $35 for a broad set of insulin products, according to a new analysis by consulting firm Avalere Health.

Among the 310 enhanced PDPs that opted to participate in CMS's Part D Senior Savings Model for 2021, the average enrollment-weighted premium is $57.53 — $23.46 higher than the average premium for non-participating plans, the analysis found. But in the MA-PD space, the average enrollment-weighted premium for the 1,287 participating plans is $10.36 less than the cost of non-participating plans ($22.74 versus $33.10).
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Teledermatology Program Reduces Patient Wait Time But Doesn't Increase Utilization

Posted by Jane Anderson on Nov 26, 2020

A pilot telemedicine program dramatically reduced the amount of time it took for primary care physicians to consult with dermatologists on skin ailments but did not increase utilization or cost, according to a new study from Independence Blue Cross and the University of Pennsylvania, AIS Health reported.

"Dermatology is an ideal specialty for telemedicine due to the visual nature of the clinical assessment," says study co-author Aaron Smith-McLallen, director of health informatics and advanced analytics at Independence Blue Cross. "Using telemedicine, patients can get quality care very quickly and reduce wait times for patients with more acute needs that are not suitable for telemedicine intervention."

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Topics: Industry Trends, Data & Analytics, Payer