Copay accumulators work by preventing any monetary assistance that pharmaceutical companies offer commercially insured patients from counting toward their deductible or out-of-pocket maximum. Their close cousin, copay maximizers, take the total amount of a manufacturer's copay offset program and divide it by 12, and that amount becomes the new monthly copayment for all patients on any given drug over the course of a year.
Copay accumulators work by preventing any monetary assistance that pharmaceutical companies offer commercially insured patients from counting toward their deductible or out-of-pocket maximum. Their close cousin, copay maximizers, take the total amount of a manufacturer's copay offset program and divide it by 12, and that amount becomes the new monthly copayment for all patients on any given drug over the course of a year.
Topics: Industry Trends, Data & Analytics, Payer
Radar On Market Access: UnitedHealth Reports 'Good Start to the Year,' But Expects COVID Earnings Hit Later
Posted by Leslie Small on Apr 22, 2021
UnitedHealth Group began the first quarter of 2021 on a high note, reporting earnings per share (EPS) and a medical loss ratio (MLR) that both beat the Wall Street consensus estimate and saying it expects to achieve greater full-year earnings than it previously estimated, AIS Health reported. However, executives warned that the majority of the unfavorable COVID-19-related impact they're expecting will transpire in the second half of the year.
UnitedHealth expects roughly 70% of the predicted COVID-related $1.80 EPS hit to occur in the back half of the year, Chief Financial Officer John Rex said during an April 15 conference call to discuss the company’s financial results. He said that projection is based on UnitedHealth's prediction that as the year wears on and vaccination rates rise, people will increasingly be able to access higher-acuity, previously deferred care.
Topics: Industry Trends, Data & Analytics, Payer
Radar On Market Access: Uber Partnership With ScriptDrop Heats Up Rx Delivery Space
Posted by Jane Anderson on Apr 20, 2021
Uber, seeking to expand its prescription delivery business nationwide, has inked a deal with pharmacy home delivery start-up ScriptDrop that makes Uber the default delivery app for a network of grocery store and independent pharmacies that spans 37 states, AIS Health reported.
The partnership, which is just one of many corporate moves in the pharmacy delivery space, positions Uber to take advantage of the vastly increased consumer demand for home delivery services sparked by the pandemic.
Topics: Industry Trends, Data & Analytics
Under the American Rescue Plan, which President Joe Biden signed into law on March 11, individuals who already qualified for premium tax credits under the ACA will see more generous financial aid. In addition, people who earn more than 400% of the federal poverty level (FPL) will be eligible for reduced premiums for the first time thanks to a provision that caps marketplace premiums at 8.5% of all enrollees' income.
Topics: Industry Trends, Data & Analytics, Payer
Radar On Market Access: Evernorth Drug Trend Report Highlights Pandemic's Impact on Utilization
Posted by Leslie Small on Apr 13, 2021
In the 2020 Drug Trend Report recently released by Evernorth, the Cigna Corp. division added yet another chapter to the growing volume of data detailing the profound effects that the COVID-19 pandemic has had on health care, AIS health reported.
On the one hand, the massive amount of deferred routine and elective health care utilization had a dampening effect on the number of new medication users that Evernorth — which houses the PBM Express Scripts — recorded in 2020. New users of asthma/COPD medications dropped the most, by 7.1% year over year, likely reflecting the avoidance of clinical settings among a group that is at particular risk of contracting severe COVID-19.
Topics: Industry Trends, Data & Analytics
The Orphan Drug Act of 1983 covers diseases that affect fewer than 200,000 people in the U.S., plus diseases that affect more than 200,000 people but are so expensive to treat that companies developing and marketing such therapies are not expected to recover their costs. With the designation, the FDA grants drugmakers expanded intellectual property and commercial rights intended to offset these steep costs.
Topics: Industry Trends, Market Access, Product Release, Data & Analytics
Radar On Market Access: Interoperability Mandate Could Be an Opportunity for Payers
Posted by Peter Johnson on Apr 8, 2021
Payers should look at the looming interoperability mandate as a chance to gain a lasting advantage over their competitors, according to two health care information technology (IT) experts.
In a March 26 webinar hosted by America's Health Insurance Plans (AHIP), IBM Vice President Michael Curry of Watson Health and Jeff Rivkin, research director for payer IT strategies at IDC Insights, said payers should do more than meet the minimum interoperability standards, AIS Health reported.
Topics: Industry Trends, Data & Analytics, Payer
Radar On Market Access: Study Highlights Promise of Bundled Payments in Employer Plans
Posted by Jane Anderson on Apr 6, 2021
A bundled payment program run by San Francisco-based digital health company Carrum Health resulted in an average per-episode savings of more than $16,000 per orthopedic or surgical procedure, a recent RAND Corp. analysis found.
Counting both procedures reimbursed under the bundled payment program and procedures reimbursed outside the program, per-episode costs for the three procedures studied — spinal fusion, major joint replacement and bariatric surgery — were 10.7% lower overall, on average, than costs for comparable procedures prior to implementation of the program. That added up to a total savings of $4,229 per episode, the study found.
Topics: Industry Trends, Data & Analytics, Payer
Cigna's Evernorth health services arm announced on Feb. 26 that it had reached an agreement with MDLive to acquire the virtual care provider, according to MDLive's website. MDLive has been available in-network as a primary care option to all members of Cigna's commercial plans since January 2020.
Topics: Industry Trends, Data & Analytics, Payer
Radar On Market Access: PBM Regulation, Rebate Rule Are High on Legislative Agenda
Posted by Peter Johnson on Apr 1, 2021
As a new bill introduced by Sen. Bernie Sanders (I-VT) indicates, Congress is once again looking seriously at tackling drug pricing reform. D.C. insiders say that Democrats could pursue big changes to PBM regulation and Medicare's ability to negotiate drug prices, AIS Health reported.
Also, Congress could repeal the Trump administration’s so-called "rebate rule," which would have removed safe-harbor protections under the federal anti-kickback statute for rebates paid by drug manufacturers to PBMs and Medicare Part D plans.
Topics: Industry Trends, Market Access, Payer