Datapoint

Datapoint: Nebraska Awards Medicaid Contracts

The Nebraska Department of Health and Human Services last week awarded 5-year Medicaid contracts to three insurers: incumbents UnitedHealthcare and Centene Corp., plus new entrant Molina Healthcare. Current contract-holder Elevance Health was not selected. Nebraska’s managed Medicaid plans currently serve 360,243 people.

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Datapoint: Lilly Scores Sweeping Label Expansion for Retevmo

The FDA last week granted a sweeping label expansion to Eli Lilly’s Retevmo, approving the drug for any cancers with locally advanced or metastatic solid tumors with rearranged during transfection (RET) gene fusion. The RET inhibitor will be available to adult patients whose tumors have not responded to prior treatments or have no alternative treatment options. Retevmo was first approved in 2020 for RET-fusion non-small cell lung cancer (NSCLC) and thyroid cancers. For these indications, the drug currently holds covered or better status for 93% of all insured lives under the pharmacy benefit. Just 6% of insured lives have preferred access to Retevmo, however, growing to 18% with utilization management restrictions applied.

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Datapoint: Judge Says United Can Complete Change Healthcare Deal

A federal judge last week said UnitedHealth Group can complete its planned acquisition of Change Healthcare Inc. The Dept. of Justice previously sued UnitedHealth in an attempt to block the deal, alleging that acquiring Change would give UnitedHealth’s OptumInsight an anticompetitive edge in health data analytics. The judge, however, said the deal could go forward so long as UnitedHealth completes its announced plans to sell Change Healthcare's ClaimsXten division to private equity fund TPG Capital for $2.2 billion. With 46,614,669 members, UnitedHealth is the largest insurer in the U.S.

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Datapoint: Appeals Court Upholds Kentucky Medicaid Awards

A panel of Kentucky appellate judges upheld the state’s challenged managed Medicaid contract awards, according to a Sept. 15 report in the Louisville Courier Journal. A lower court previously ordered the 2020 awards rebid, following a suit from Elevance Health, which was not initially selected to keep its contract. Parties have until Oct. 9 to further appeal the decision. Kentucky’s managed Medicaid population is currently served by six MCOs, led by Centene Corp., with 484,498 members. Elevance, meanwhile, serves 171,734 Kentucky Medicaid lives.

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Datapoint: Highmark Launching New Primary Care Initiative in Pittsburgh

Highmark Health is partnering with value-based primary care provider AbsoluteCare to bring concierge-style primary care services to its public-sector members in Pittsburgh. Members will have access to same-day urgent care, behavioral health services and a pharmacy on-site. AbsoluteCare also operates in Atlanta, Baltimore, New Orleans and Philadelphia. Highmark is the largest insurer in Pennsylvania, with 2,342,027 members. It serves 324,557 managed Medicaid beneficiaries in the state.

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Datapoint: Novartis Asks FDA to Stave Off Early Entresto Copies

Novartis last week asked the FDA not to approve any generic copies of its heart failure drug Entresto before its exclusivity period ends in February 2024, citing labeling concerns. The agency denied a similar request from the drugmaker in April. For the treatment of heart failure, Entresto holds covered or better status for virtually all covered lives (99%) under the pharmacy benefit. 66.3% of insured lives have preferred access to Entresto without utilization management restrictions. The drug will likely face heavy competition, with at least 18 generic versions in development.

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Datapoint: Oregon Adds Mobile Crisis Intervention to Medicaid Program

Oregon is launching a first-of-its-kind mobile crisis intervention program for its Medicaid population, according to CMS. Medicaid beneficiaries experiencing substance abuse or mental health issues will be able to contract a behavioral health specialist 24 hours per day. CMS said these programs can reduce costs for inpatient mental health treatments and burdens on law enforcement. Oregon currently serves 1,300,577 Medicaid beneficiaries.

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Datapoint: FDA Approves First TYK2 Inhibitor for Psoriasis

The FDA on Sept. 9 approved Bristol Myers Squibb’s Sotyktu for the treatment of moderate-to-severe plaque psoriasis in adult patients. It’s a first-in-class win for the selective allosteric tyrosine kinase 2 (TYK2) inhibitor. BMS acquired Sotyktu as part of its 2019 merger with Celgene Corporation, with Amgen purchasing Celgene’s extant immunology drug Otezla in order for regulators to approve the deal. But now Otezla may be in trouble with Sotyktu on the market, as the TYK2 inhibitor proved more affective than Otezla in clinical trials. For the treatment of psoriasis, 98% of all insured lives have covered or better access to Otezla under the pharmacy benefit. 8.6% of lives have preferred access to Otezla, growing to 54.3% with utilization management restrictions applied.

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Datapoint: Iowa Awards Medicaid Contracts

Iowa’s Dept. of Health and Human Services on Aug. 31 unveiled new Medicaid contract awards for Elevance Health and Molina Healthcare, which will join Centene Corp. in serving the state’s managed Medicaid program. Elevance Health’s Amerigroup Iowa already serves Iowa’s Medicaid population, while Molina will be a new entrant. “This third MCO will enhance choice for members and incent innovation in the Iowa Medicaid program, “the state’s announcement read. “The new contracts are slated to begin July 1, 2023. Centene and Elevance currently serve 784,752 Iowa Medicaid lives combined.

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Datapoint: Wellmark, UnityPoint Partner on Exchange Products

Wellmark Blue Cross and Blue Shield of Iowa and UnityPoint Health, a large, Des Moines-based health system, are partnering to offer Affordable Care Act exchange products in Iowa for the 2023 plan year. Benefits will include low-cost copays for primary care visits, and $0 telehealth. Wellmark is currently the largest insurer in Iowa, with 1,084,489 members, or 30.7% of the overall market. It is also the exchange market leader in the state, with 29,000 members.

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