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Radar On Market Access: 1.7K Plans Apply for Trump Admin's Fixed-Insulin-Copay Program for Seniors

Posted by Leslie Small on Jun 4, 2020

The Trump administration on May 26 shared new details about a program that offers diabetic seniors access to a variety of insulin products for a maximum $35-per-month copay, AIS Health reported.

More than 88 health insurers offering about 1,750 standalone Medicare Part D Prescription Drug Plans and Medicare Advantage plans with prescription drug coverage have now applied to participate in the Part D Senior Savings Model, which CMS unveiled in mid-March. Medicare beneficiaries in all 50 states, the District of Columbia and Puerto Rico will be able to enroll in a participating plan during the Medicare open enrollment period that lasts from Oct. 15 to Dec. 7, 2020, for Part D coverage that begins on Jan. 1, 2021.

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: Payers and PBMs May Play Key Role in COVID-19 Vaccine Rollout

Posted by Peter Johnson on Jun 2, 2020

The rollout of a vaccine for SARS-CoV-2, the virus that causes COVID-19, is an unprecedented logistical challenge. So will be deciding who gets it: experts say that the initial vaccine supply will not be large enough to dose everyone who wants it — and payers and PBMs will have a large role to play in distributing the medicine to the right people quickly.

David Simchi-Levi, Ph.D., a systems engineer who studies manufacturing and supply chain at MIT, tells AIS Health that it's inevitable that vaccine supply will not meet demand when it is available. "The question will be, who gets it?" he says.

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Perspectives on Surge of Mental Health Meds Use Amid COVID-19

Posted by Leslie Small on May 28, 2020

Newly released data from Express Scripts shows that the number of prescriptions filled per week for antidepressants, anti-anxiety and anti-insomnia medications combined jumped 21% between mid-February and mid-March — reaching a zenith during the week ending March 15, when the COVID-19 outbreak officially reached pandemic status. And analytics from UnitedHealth Group's OptumRx showed prescription increases of 15% for anti-anxiety medications, 14% for antidepressants and 5% for anti-insomnia medications during the month of March.

Industry consultants tell AIS Health that they're not at all surprised that the use of such medications is spiking. And they say that situation creates an urgent opportunity for companies that combine a health insurer with a PBM — like Express Scripts parent company Cigna Corp. and its peers — to leverage their unique insights into members' health.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: Will COVID-19 Advance Automatic Health Insurance Enrollment?

Posted by Leslie Small on May 28, 2020

As the COVID-19 pandemic continues to ravage the U.S. economy, it would seem to be the perfect time for policymakers to explore a policy option that has garnered rare bipartisan support: automatic health insurance enrollment.

"We have huge numbers of people who are losing employer-based coverage; most of them are eligible for some kind of help, but we know historically most laid-off workers do not enroll in coverage for which they qualify," Stan Dorn, director of the National Center for Coverage Innovation and senior fellow at Families USA, told AIS Health. "It's just overwhelming to be grappling with job loss and therefore it becomes imperative to make enrollment as easy, seamless and automatic as possible."

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: COVID-19 Pandemic May Change Rx Delivery Permanently

Posted by Peter Johnson on May 26, 2020

Industry experts expect the COVID-19 pandemic and related economic crisis, in addition to the trend of vertical integration in the PBM sector, will increase those companies' direct interaction with consumers, AIS Health reported.

The recent wave of payer acquisitions of PBMs has kept the latter on strong footing despite the crisis. CVS Health Corp.'s Caremark, UnitedHealth Group's OptumRx and Cigna Corp.'s Express Scripts control approximately 74% of the market, according to a January 2020 estimate by Drug Channels Institute CEO Adam Fein, Ph.D.

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: COVID-19 Pandemic Drives Home Infusion Utilization

Posted by Angela Maas on May 21, 2020

With numerous hospitals focused on the COVID-19 pandemic and many areas under stay-at-home mandates, home infusion is more important than ever. Changes within the industry already have been seen, and the current situation is likely to result in permanent shifts within the home infusion space, AIS Health reported.

"If you can do infusion at home, you need to do it there," maintains Ashraf Shehata, KPMG national sector leader for Healthcare & Life Sciences. "This is about controlling infection risk in the near term, and many home infusion candidates are in a high-risk category. Longer term, there has been a shift toward delivering care in the most economical and clinically appropriate setting, largely driven by payers."

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: PBMs See Solid 1Q Results Despite Challenges Ahead

Posted by Jane Anderson on May 19, 2020

Major PBMs reported strong results for the first quarter of 2020 as members rushed to fill prescriptions in March ahead of the COVID-19 pandemic. However, financial analysts warn the pandemic could have unpredictable effects on PBMs' finances for the rest of 2020 and moving into 2021, AIS Health reported.

The 2021 PBM selling season could be disrupted in still-unknown ways, analysts said, and members are cutting back on routine physician visits and elective procedures, resulting in lower script volume overall.

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Topics: Data & Analytics, Provider, Payer

Perspectives on Coronavirus Antibody Testing

Posted by Peter Johnson on May 14, 2020

With the Trump administration anxious to "reopen" the U.S. economy and ease the social-distancing measures meant to slow the spread of COVID-19, officials have pointed to antibody testing as a critical tool to accomplish those goals. To that end, the administration on April 11 issued a document clarifying that most private health plans must cover such tests, which detect antibodies against the new coronavirus found in the blood of people who have been infected and now may be immune.

"It's not exactly a surprise, [but] I don’t know that it was 100% expected," Jason Karcher, a Milliman Inc. actuary, tells AIS Health regarding the requirement. "It seems like as much a point of clarification rather than a 'hey, we're going to require something totally out of the blue.'"
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: COVID-19 May Drive More Insurers Into ACA Exchanges

Posted by Leslie Small on May 14, 2020

As the impact of the COVID-19 pandemic continues to reverberate throughout the U.S. economy, it's become clear that there will be a major enrollment shift away from employer-sponsored plans and into Medicaid and the individual market, AIS Health reported.

In fact, one recent analysis suggested that there could be "unprecedented growth" in the individual health insurance market. "The impact of COVID-19-related job losses will likely more than double the current enrollment in Individual & Marketplace plans, with the potential for the Individual market to triple in size to over 35 million in a sustained and severe economic contraction," stated the analysis from A2 Strategy Group.

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: CVS Sees COVID Testing Sites as Part of Bigger HealthHUB Strategy

Posted by Leslie Small on May 12, 2020

Since acquiring Aetna, CVS Health Corp. has touted its HealthHUB stores — which include expanded clinics, labs for health screening and space for wellness pursuits — as the linchpin of its plan to stand out among other large, diversified firms that include a health insurer. Yet as one analyst pointed out during CVS’s first-quarter 2020 earnings call on May 6, that strategy could face new challenges amid the COVID-19 pandemic when many people are reluctant to venture outside their homes.

CVS executives said that while the company is indeed seeing less foot traffic at its brick-and-mortar locations, it is still leveraging the power of having a vast retail footprint by offering testing for the new coronavirus, AIS Health reported.

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Topics: Industry Trends, Data & Analytics, Provider, Payer