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Radar on Market Access: Kansas Works Out Medicaid Expansion Deal

Posted by Lauren Flynn Kelly on Jan 21, 2020

Kansas Gov. Laura Kelly (D) and Republican Senate Majority Leader Jim Denning on Jan. 9 said they’d reached a compromise proposal to extend Medicaid coverage to an estimated 130,000 more low-income Kansans, AIS Health reported.

If approved, Kansas will pursue a full expansion of Medicaid to 138% of the Federal Poverty Level (FPL) with a 90/10 funding match. The state will also seek Section 1332 waiver approval to establish a reinsurance program and Section 1115 waiver approval to transition individuals whose incomes fall between 100% and 138% of the FPL from Medicaid to the exchange no later than Jan. 1, 2022, although expansion is not dependent on those waivers. If CMS denies either waiver, full Medicaid expansion will be implemented on Jan. 1, 2021, according to a summary of the pending legislation.

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Topics: Industry Trends, Provider, Payer

MMIT Reality Check on Prostate Cancer (Jan 2020)

Posted by Matt Breese on Jan 17, 2020

According to our recent payer coverage analysis for prostate cancer 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: State Lawmakers Tee Up Bills on PBMs, Drug Pricing This Year

Posted by Jane Anderson on Jan 16, 2020

State lawmakers will continue to focus on the cost of prescription drugs as the 2020 legislative season gets underway, potentially advancing measures to require the disclosure of manufacturer drug pricing information and bills to limit or eliminate the role PBMs play in state Medicaid programs, AIS Health reported.

However, the abbreviated length of the election-year legislative sessions, plus some unexpected hiccups in states that already have passed bills on those issues, could limit how much actually gets done at the state level in 2020, legislative observers say.

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Topics: Data & Analytics, Provider, Payer

Radar On Market Access: 2020 Could Be 'Wild Year' for Consolidated PBMs

Posted by Leslie Small on Jan 14, 2020

Though the two major transactions that upended the PBM landscape — Cigna Corp. buying Express Scripts Holding Co. and CVS Health Corp. acquiring Aetna Inc. — have already taken place, that doesn't mean the sector won't see more changes this year, industry experts tell AIS Health.

"The market is evolving," says Brian Anderson, a principal with Milliman, Inc. The year 2020 will be marked by a presidential election and significant price pressure on manufacturers, along with pharmacies trying to retain their margin, he adds, "so it's going to be a really wild year."

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

MMIT Reality Check on Cystic Fibrosis (Jan 2020)

Posted by Matt Breese on Jan 10, 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 UnitedHealth/Diplomat Deal

Posted by Leslie Small on Jan 9, 2020

Diplomat Pharmacy, Inc., which has been in a tailspin amid mounting financial losses, agreed to a deal with UnitedHealth Group on Dec. 9 that will see the larger firm's OptumRx division purchase the midsized specialty pharmacy provider/PBM, AIS Health reported.

Diplomat's difficulties began to come into focus earlier this year, when the firm disclosed customer losses in its PBM business and "increased competitive pressure in the specialty market." In August, Diplomat said it was "reviewing strategic alternatives" to maximize shareholder value. Then on Dec. 9, UnitedHealth disclosed that it agreed to pay $4 per share for Diplomat's outstanding stock and assume its debt. Equities analysts noted that Diplomat's stock was trading at $5.81 as of market close on the Friday before the transaction was unveiled.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Health Care Deals May Slow in 2020, but Government Markets Remain Hot

Posted by Jane Anderson on Jan 9, 2020

The pace of health care mergers and acquisitions likely will cool slightly in 2020, some industry experts tell AIS Health. Still, insurers are likely to seek out companies with assets such as care management or information technology solutions, while provider consolidation will continue in certain markets, AIS Health reported.

"We expect that payer M&A will continue into 2020, with a bias toward vertical rather than horizontal deals," says Michael Abrams, managing partner of Numerof & Associates, Inc. "Payers will use such deals to expand into adjacent market spaces to differentiate their offerings as integrated platforms that can deliver superior value, customer experience and innovation."

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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Navajo Nation, Molina Partner on Medicaid Managed Care in New Mexico

Posted by Jane Anderson on Jan 7, 2020

The business arm of the Navajo Nation plans to contract with Molina Healthcare, Inc., to offer Medicaid managed care as part of a partnership between New Mexico, tribal officials and the insurer, AIS Health reported.

The program would be the first-ever Medicaid managed care program dedicated solely to the health care, cultural needs and geographic needs of native populations living in the Navajo Nation, according to Molina.

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Topics: Data & Analytics, Provider, Payer

MMIT Reality Check on Growth Hormone Deficiency (Jan 2020)

Posted by Matt Breese on Jan 3, 2020

According to our recent payer coverage analysis for growth hormone deficiency 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: New Sickle Cell Medications Offer Both Opportunities and Challenges

Posted by Judy Packer Tursman on Jan 2, 2020

The first targeted therapy to treat pain crises in people with sickle cell disease presents a "welcome" new option that payers likely will embrace, a PBM head tells AIS Health. While the drug's manufacturer cites "positive" early discussions with payers on it, some experts note the lifetime treatment — via a monthly intravenous infusion — is costly: around $100,000 annually.

On Nov. 15, the FDA approved Novartis' Adakveo (crizanlizumab-tmca), a treatment to fight the underlying cause and reduce the frequency of vaso-occlusive crisis, described as a common and painful complication of sickle cell disease. It is approved for patients ages 16 and older with the genetic blood disorder.

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