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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

Radar On Market Access: Centene Expands ACA Footprint But Faces More Competition

Posted by Leslie Small on Nov 24, 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

MMIT Reality Check on Multiple Myeloma (Nov 2020)

Posted by Matt Breese on Nov 20, 2020

According to our recent payer coverage analysis for multiple myeloma 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

Radar On Market Access: Biden Administration's Drug-Pricing Moves May Be Limited

Posted by Leslie Small on Nov 17, 2020

As is the case for other flavors of health care reform, President-elect Joe Biden's chance of passing substantial, transformative drug-pricing legislation is now highly dependent upon whether Democrats can eke out a majority in the Senate. While that question won't be resolved until Georgia completes runoff elections in January, industry observers point out that there are still ways that a Biden administration can address drug pricing, AIS Health reported.

"A president can do a lot even with a divided Congress," says Stephanie Kennan, a member of McGuireWoods Consulting's federal public affairs group. "Part of how well something gets done…depends upon the skills of the president or those negotiating for him. With Biden perhaps having a better understanding of the Senate, having come from the Senate, [that] might help him."

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Topics: Industry Trends, Payer

MMIT Reality Check on Cystic Fibrosis (Nov 2020)

Posted by Matt Breese on Nov 13, 2020

According to our recent payer coverage analysis for cystic fibrosis 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 MA Star Ratings

Posted by Lauren Flynn Kelly on Nov 12, 2020

Although more than three-quarters of Medicare Advantage beneficiaries remain in highly rated plans, roughly 77% of MA Prescription Drug (MA-PD) members are currently in contracts that will have 4 or more stars in 2021, down from about 81% in 2020, estimated CMS.

Approximately 49% of MA-PD plans (194 contracts) that will be offered in 2021 earned overall star ratings of 4 or higher, compared with 52% of MA-PDs (210 contracts) offered in 2020, according to CMS.
 
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: What's Next for Health Insurers in a Likely Split Congress?

Posted by Leslie Small on Nov 12, 2020

Though the new makeup of Congress may not be cemented until runoff elections take place in Georgia, perhaps the most consequential outcome of the 2020 general elections for the health insurance industry is that no one political party is likely to control the White House and both chambers of Congress, AIS Health reported.

"[I]t is evident there is no 'blue wave' as Republicans appear to have held the Senate," Citi analyst Ralph Giacobbe advised investors on Nov. 5. "The news drove significant outperformance within the managed care space," he observed. On Nov. 7, the presidential election was called in favor of former Vice President Joe Biden.

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Topics: Industry Trends, Payer

Radar On Market Access: Humana Reports Strong Earnings, But Expects Fourth-Quarter Loss

Posted by Leslie Small on Nov 10, 2020

While Humana Inc. has seen its profits swell as members avoided non-coronavirus-related care during the pandemic, the company is making it crystal clear that those financial gains will be erased before the year is over, AIS Health reported.

"We continue to expect our results for the second half of 2020, including an anticipated loss in the fourth quarter, to entirely offset the significant outperformance experienced in the first half of the year that resulted from historically low medical utilization levels," Chief Financial Officer Brian Kane said during Humana's third-quarter earnings call, according to a transcript from The Motley Fool.

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Topics: Industry Trends, Data & Analytics, Payer

MMIT Reality Check on Chronic Lymphocytic Leukemia (Nov 2020)

Posted by Matt Breese on Nov 6, 2020

According to our recent payer coverage analysis for chronic lymphocytic leukemia (CLL) 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