Venture-backed insurance startup Friday Health Plans “will begin to wind down its business activities throughout the country, working in close conjunction with state regulators,” the Colorado Division of Insurance (DOI) said on June 1. The insurtech has been placed into receivership by two states, Georgia and Texas, in recent weeks. “While Friday Health Plan of Colorado has maintained the capital required by Colorado law, the problems in other states and with the parent company are now impacting the company here,” Colorado Insurance Commissioner Michael Conway said in a statement. The Affordable Care Act exchange-focused insurer enrolled 398,260 members in seven states as of the latest update to AIS’s Directory of Health Plans.
Datapoint: Kaiser Commits Up to $10M in Funding to Colorado System
Kaiser Permanente said it will commit up to $10 million to Denver Health, a Colorado-based health system. Its Denver Health Medical Center serves as the Denver area’s “safety-net hospital,” and provides care to more than one-third of the Denver population, according to a May 30 press release. Kaiser’s funding, which includes an upfront $5 million grant, will “assist Denver Health with vital health care services for the community, including continued access to primary and specialty care for people who do not have the means to pay.” Denver Health’s insurance arm, Denver Health Medical Plan, currently serves 133,790 lives, with 84.7% enrolled in Medicaid managed care.
Datapoint: FDA Approves Lexicon’s Heart Failure Drug
The FDA on May 26 approved Lexicon Pharmaceuticals’ Inpefa (sotagliflozin) to reduce the risk of heart failure in select patient populations, including adults with Type 2 diabetes and chronic kidney disease. The once-daily pill will be the first SGLT1/SGLT2 inhibitor in the market basket, and is expected to launch by the end of June. Among the most advantaged therapies for chronic heart failure are AstraZeneca’s Farxiga, which is placed on the preferred tier for 49.6% of all insured lives under the pharmacy benefit, and Boehringer Ingelheim and Eli Lilly’s Jardiance, which is preferred for 65.11% of lives.
Datapoint: FDA Approves Celltrion’s Humira Biosimilar
The FDA last week approved Celltrion Healthcare’s high-concentration Humira biosimilar, Yuflyma, for eight of Humira’s indications. The company expects to launch the drug, which will be available as both a pre-filled syringe and autoinjector, in July, alongside several other Humira copies from other drugmakers. Celltrion is also seeking interchangeability status from the FDA, and anticipates a decision in the fourth quarter of 2024. The first Humira biosimilar, Amgen’s Amjevita, launched Jan. 31. For the treatment of rheumatoid arthritis, the Amjevita autoinjector currently holds covered or better status for 67% of all insured lives under the pharmacy benefit.
Datapoint: Minnesota to Adopt Public Option Insurance
Minnesota’s state legislature last week passed legislation that will establish public option health insurance in the state by 2027, joining Colorado, Washington and Nevada in similar efforts. Next year, the state will conduct an actuarial analysis on the initiative, which would serve as an expansion of MinnesotaCare, a state health plan for people living below 200% of the federal poverty line. Payer groups such as AHIP and Minnesota-based health systems have rallied against the proposal. The three largest payers in Minnesota are Blue Cross and Blue Shield of Minnesota (2,166,301 members), the provider-sponsored insurer HealthPartners (903,759 members) and nonprofit insurer Medica (663,434 members).
Datapoint: Mass. Blues Adds Tufts Medicine to ‘Pay-for-Equity’ Model
Boston-based health system Tufts Medicine has joined Blue Cross Blue Shield of Massachusetts’ pay-for-equity financial payment model that launched earlier this year, according to a May 23 press release. The arrangement, the first of its kind in Massachusetts, seeks to address health inequities and decrease racial gaps in health care. The Blues insurer said with the addition of Tufts, 53% of its members are now receiving care from providers within the initiative. Blue Cross Blue Shield of Massachusetts is the largest insurer in its home state, serving 2,229,079 members. About 38% of its members are enrolled in commercial risk-based products, with an additional 58% served via self-funded arrangements with employer groups.
Datapoint: AbbVie Scores Crohn’s Nod for Rinvoq
The FDA on May 18 approved AbbVie’s Rinvoq for the treatment of moderately to severely active Crohn’s disease in adult patients who have had an inadequate response or intolerance to at least one TNF blocker. The nod becomes the JAK inhibitor’s second approval in gastroenterology, and its seventh overall. Rinvoq will also be the first JAK inhibitor in the Crohn’s market basket. The drug was first approved in 2019 for the treatment of moderate-to-severe rheumatoid arthritis, an indication for which it currently holds covered or better status for 96% of all insured lives in the U.S. About 63% of insured lives have preferred access to Rinvoq, largely with utilization management restrictions applied. Rinvoq was AbbVie’s sixth best-selling drug worldwide in 2022, bringing in $2.52 billion in sales, according to Evaluate Pharma. Evaluate projects the JAK inhibitor will be AbbVie’s No. 2 bestseller by 2025.
Datapoint: Supreme Court Ends Repatha-Praluent Patent Saga
The United States Supreme Court on May 18 ended a long-running patent dispute between Amgen, Sanofi and Regeneron over the drugmakers’ PCSK9 inhibitors. Justices upheld a 2019 lower court ruling, which stated that Amgen could not make patent claims over monoclonal antibodies without more thoroughly describing their molecular structure, a decision that could have wider implications for the pharmaceutical industry as a whole. Praluent and Repatha are both approved to treat three forms of high low-density lipoprotein cholesterol (LDL-C); heterozygous familial hypercholesterolemia (HeFH), atherosclerotic cardiovascular disease (ASCVD), and homozygous familial hypercholesterolemia (HoFH). Under the pharmacy benefit, Repatha SureClick holds covered or better status for 82% of all insured lives, to Praluent Pen’s 71%.
Datapoint: Oscar to Exit California Exchange Market
Oscar Health will exit the California Affordable Care Act exchange market, Covered California, for the 2024 plan year, executives revealed during the insurance startup’s first-quarter 2023 earnings call. The California exit is part of a push toward profitability, as the plan “has not met our targets,” CEO Mark Bertolini said during the call. Oscar is currently the seventh-largest exchange insurer in the state, serving 44,658 members. Oscar is the fourth-largest exchange insurer nationally, with 977,408 members.
Datapoint: Sentara to Combine Medicaid Plans
Sentara Healthcare, a Norfolk, Va.-based nonprofit health systems of 14 hospitals that also operates a health insurer, said it will combine its Medicaid products into a single plan. The two plans, Virginia Premier and Optima Health, will be united under the Optima Health name beginning July 1. “[This] will enable us to continue to provide a superior customer experience for our Medicaid membership — while also creating efficiencies that support lower costs for the state and reduced administrative burden on health care providers, Colin Drozdowski, president of Sentara Health Plans, said in a May 10 press release. Virginia Premier’s dual eligible Special Needs Plan will continue to operate as Virginia Premier. Virginia Premier currently enrolls 318,705 Medicaid and CHIP members to Optima Health’s 314,982. Sentara is the largest managed Medicaid insurer in Virginia.