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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

Trends That Matter for High-Touch Care Management for Chronic Conditions

Posted by Leslie Small on Sep 26, 2019

Though PBMs are most known for the influence they have on prescription drug costs, some firms are increasingly focused on offering high-touch condition management services that give them a more active role in patient care, AIS Health reported.

For specialty PBM AscellaHealth, LLC, that means harnessing a variety of resources to help better manage treatment for hemophilia, a notoriously expensive disease state.
 
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Topics: Industry Trends, Market Access, Data & Analytics

Radar On Market Access: Industry Groups Praise OIG Report on Medicare Part D Rebates

Posted by Lauren Flynn Kelly on Sep 26, 2019

Industry trade groups that would like rebates preserved in the Medicare Part D purchasing system were thrilled to see a Sept. 13 report from the HHS Office of Inspector General that they viewed as dispelling the oft-purported "myth" that rebates are responsible for high drug prices, AIS Health reported.

The report examining the more than 1,510 brand-name drugs with Part D reimbursement and rebates between 2011 and 2015 found that rebates did not always go up when unit reimbursement grew.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Trends That Matter for RM/AT Products

Posted by Angela Maas on Sep 12, 2019

This past quarter saw two new gene therapies: Novartis AG subsidiary AveXis, Inc.'s Zolgensma (onasemnogene abeparvovec-xioi) received FDA approval May 24 for the treatment of spinal muscular atrophy, and bluebird bio's Zynteglo (autologous CD34+ cells encoding βA-T87Q- globin gene) received conditional marketing authorization from the European Commission for transfusion-dependent beta thalassemia.

While only a handful of therapies in the broader regenerative medicine/advanced therapy (RM/AT) space are available globally, a new report shows that is likely to change, as there are more than 1,000 products in the pipeline, AIS Health reported.
 
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Topics: Specialty, Industry Trends, Product Release, Data & Analytics

Trends That Matter for Hepatitis C Drugs

Posted by Leslie Small on Aug 29, 2019

Beginning last month, Louisiana has been able to treat hundreds of patients who were waiting to receive a pricey cure for hepatitis C thanks to after hammering out an innovative payment model with a drug manufacturer, AIS Health reported.

But the road to get there was long and difficult, according to Rebekah Gee, M.D., secretary of the Louisiana Dept. of Health, who, during a July 22 event hosted by the Brookings Institution, detailed the challenges she faced in trying to get a costly curative therapy to more people while facing down a $2 billion budget deficit. "We were told 'No' at least 50 times from a variety of people, whether it was the industry, or policymakers or individuals at the CDC…because it had never been done before," she said.
 
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Topics: Industry Trends, Data & Analytics

Perspectives on Blockchain Technology

Posted by Judy Packer Tursman on Aug 22, 2019

Industry consultants from Milliman Inc. assert in a July 11 report that blockchain — which is described as a real-time digital ledger for building secure networks — "could potentially transform the relationship between payers, pharmaceutical manufacturers, wholesalers, and pharmacies by offering an alternative, transparent mechanism for processing, pricing, and validating prescription transactions."

Using blockchain technology, payers and pharmacies would reduce the time they spend validating insurance coverage, making phone calls and managing data, Milliman explains. The firm is urging PBMs to work to "evaluate a blockchain alternative now with an eye toward a more efficient drug financing system" capable of handling additional technology improvements, AIS Health reported.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Trends That Matter for Medicare Part D Costs

Posted by Leslie Small on Aug 15, 2019

A recently published study in Health Affairs shines a light on a peculiar quirk of the Medicare Part D benefit structure: For some high-priced specialty medications, seniors might pay less out-of-pocket for brand-name drugs than their generic counterparts.

The study found that, assuming a 61% discount between brand-name and generic drugs, Part D beneficiaries with prescriptions costing between $22,000 and $80,000 per year would have lower out-of-pocket spending if they use brand-name drugs over a generic, AIS Health reported.
 
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Topics: Industry Trends, Product Release, Data & Analytics

Trends That Matter for CMS's Oncology Care Model

Posted by Angela Maas on Aug 1, 2019

CMS's Oncology Care Model (OCM) is about halfway through its five-year pilot. Developed by the CMS Center for Medicare & Medicaid Innovation, the voluntary pilot is aimed at providing better quality and more coordinated cancer care for Medicare fee-for-service beneficiaries, as well as other payers, while at a lower cost.

One criticism of the model is that providers' costs are compared with targeted costs that are based partly on their spending from 2012 to 2015, the OCM baseline period. When the actual costs come in below the targeted costs, that earns providers a performance-based payment. But with so many costly oncology therapies launching after the baseline period, this is making it hard for providers to gain a performance-based payment, AIS Health reported.
 
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Topics: Industry Trends, Product Release, Data & Analytics

Radar On Market Access: Will Blockchain Transform Relationships Industry Wide?

Posted by Judy Packer Tursman on Jul 30, 2019

Industry consultants from Milliman Inc. assert in a July 11 report that blockchain — which is described as a real-time digital ledger for building secure networks — "could potentially transform the relationship between payers, pharmaceutical manufacturers, wholesalers, and pharmacies by offering an alternative, transparent mechanism for processing, pricing, and validating prescription transactions."

Using blockchain technology, payers and pharmacies would reduce the time they spend validating insurance coverage, making phone calls and managing data, Milliman explains. The firm is urging PBMs to work to "evaluate a blockchain alternative now with an eye toward a more efficient drug financing system" capable of handling additional technology improvements, AIS Health reported.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer