Datapoint

Datapoint: Elevance Health to Acquire BCBS Louisiana

National Blues powerhouse Elevance Health has entered an agreement to acquire Blue Cross and Blue Shield of Louisiana, a move that would unite the two payers under Elevance’s Anthem branding. The two orgs are already joint owners of Healthy Blue, a Louisiana Medicaid plan. BCBSLA’s 1,049,170 members would expand Elevance’s presence in the state by 281%. Financial terms of the deal, which Elevance expects to close later this year, were not disclosed.

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Datapoint: Seagen Scores Colorectal Cancer Nod for Tukysa

The FDA last week granted an accelerated approval to Seagen’s Tukysa in combination with Herceptin as a second-line therapy for RAS wild-type, HER2-positive unresectable or metastatic colorectal cancer. The combination is the first FDA-approved therapy in HER2-positive metastatic colorectal cancer. Tukysa was first approved in 2020, also in combination with Herceptin, for the treatment of advanced unresectable or metastatic HER2-positive breast cancer. For this indication, the drug currently holds covered or better status for virtually all (99%) of insured lives in the U.S. under the pharmacy benefit. About 8% of covered lives have preferred access to Tukysa, growing to 25% with utilization management restrictions applied.

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Datapoint: Georgia Doubles Down on Partial Medicaid Expansion Waiver

The state of Georgia has no plans to implement a full Medicaid expansion, according to a Jan. 20 report in the Atlanta Journal-Constitution. The state’s newly elected House Speaker, Jon Burns (R), told reporters lawmakers will instead work toward installing Gov. Brian Kemp (R)’s partial expansion plan, a waiver program that would allow low-income adults to enroll in Medicaid if they meet a work requirement. The Trump administration approved the program, Georgia Pathways to Coverage, in October 2020, and the state hopes to begin implementation by this summer. Georgia currently serves 2,799,066 Medicaid beneficiaries, with 76.7% enrolled in managed care plans. The state estimates about 50,000 additional lives would enroll under Pathways to Coverage.

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Datapoint: FDA Rejects Biocon’s NovoLog Biosimilar

The FDA recently rejected Biocon Biologics’ latest biosimilar insulin product, a copy of Novo Nordisk’s NovoLog, citing a need for additional data and pending improvements at the company’s manufacturing facilities. Biocon is the manufacturer of Semglee, a biosimilar for Sanofi’s insulin Lantus. As a short-acting mealtime insulin for the treatment of type 2 diabetes, NovoLog currently holds covered or better status for 74% of all insured lives. 52.5% of lives have preferred, unrestricted access to NovoLog without.

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Datapoint: FDA Approves Luye Pharma’s Risperdal Consta Competitor

The FDA on Jan. 15 approved Luye Pharma Group’s long-acting injectable Rykindo for the treatment of schizophrenia and bipolar I disorder in adult patients. The Chinese drugmaker will have to face off against Johnson & Johnson’s Risperdal Consta, which has long dominated the market. Like Rykindo, Risperdal Consta is administered every two weeks. J&J also has a newer schizophrenia product line, Invega, that can be administered as little as twice per year. For the treatment of schizophrenia, Risperdal Consta holds covered or better status for 79% of all insured lives under the pharmacy benefit and 90% of lives under the medical benefit.

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Datapoint: Sentara Finalizes AvMed Acquisition

Norfolk, Virginia-based health system Sentara Healthcare has finalized its purchase of nonprofit health insurer AvMed. The deal will expand Sentara’s presence to Florida, where Miami-based AvMed currently serves 230,785 medical lives in its commercial health insurance products. Sentara’s health insurance subsidiaries, Optima Health and Virginia Premier, cover 553,005 members in North Carolina, Ohio and Virginia. Sentara is the sixth-largest insurer in Virginia.

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Datapoint: Blue Cross of Idaho Expands Value-Based Care Arrangements

Blue Cross of Idaho will expand its value-based care arrangements to 15 partnerships, encompassing more than 3,000 providers, for the 2023 plan year. The insurer said 70% of its member claims were processed through its value-based arrangements, which cover its Affordable Care Act exchange, Medicare Advantage and commercial offerings, in 2022. The Blues affiliate is currently the largest insurer in its home state, with 554,670 members.

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Datapoint: FDA Approves Genentech’s Lunsumio in Follicular Lymphoma

The FDA last month approved Genentech’s Lunsumio as a third-line treatment for follicular lymphoma, pitting the bispecific antibody against the CAR-T class: Bristol Myers Squibb’s Breyanzi, Gilead’s Yescarta and Novartis’ Kymriah. Genentech says Lunsumio has an advantage over its CAR-T rivals as an “off-the-shelf, accessible treatment option” that can be administered in an outpatient setting. Under the medical benefit, Breyanzi is currently the most advantaged of the three CAR-T therapies in the treatment of follicular lymphoma, holding covered or better status for 83% of all insured lives.

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Datapoint: Intermountain’s SelectHealth to Expand to Colorado

Intermountain Healthcare is partnering with Aurora, Colo.-based health system UCHealth to expand its insurance offerings to Colorado. The value-based care focused initiative will create an integrated network of more than 700 primary care physicians across hundreds of sites-of-care, and bring SelectHealth’s Medicare Advantage and Affordable Care Act exchange products to Colorado in 2024. SelectHealth, Intermountain’s health insurance subsidiary, currently serves 995,185 members across Idaho, Nevada and Utah. It is the largest insurer in Utah.

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Datapoint: FDA Approves TG Therapeutics’ MS Antibody Briumvi

The FDA on Dec. 28 approved TG Therapeutics, Inc.’s Briumvi for the treatment of relapsing forms of multiple sclerosis. The monoclonal antibody will be the third anti-CD20 therapy in the relapsing MS market basket, joining Roche’s Ocrevus and Novartis’ Kesimpta. Briumvi boasts a novel administration, however — a one-hour infusion every six months following its four-hour starting dose. For the treatment of MS, Ocrevus holds covered or better status for 66% of all insured lives under the pharmacy benefit and 92% of lives under the medical benefit. Kesimpta, meanwhile, holds covered or better status for 85% of insured lives under the pharmacy benefit, and 13% of lives under the medical benefit.

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