Philadelphia-based Blues affiliate Independence Blue Cross on Jan. 26 said it will launch an Advanced Network for Gene-Based Therapeutics in March of this year. The insurer is partnering with Penn Medicine and Children’s Hospital of Philadelphia in the creation of the new network, noting both providers “have played pivotal roles in the development and clinical trials of first-in-the-nation gene-based therapies.” While the network is intended to help Independence members access gene therapies, the press release noted that Luxturna and Zynteglo, both covered under Independence’s medical benefit, will “continue to require precertification.” Independence is currently the second-largest insurer in Pennsylvania, with 1,993,695 members.
Bristol Myers Squibb last week sued AstraZeneca in a Delaware federal court, alleging the drugmaker’s new Imjudo violates two of Yervoy’s patents. Imjudo, a CTLA-4 inhibitor, was granted FDA approval for the treatment of liver and lung cancer in 2022. Yervoy, meanwhile, is an oncology blockbuster, and was BMS’s No. 6 bestselling drug in 2021, bringing in $2.03 billion in sales. As a systemic therapy for non-small cell lung cancer (NSCLC) — one of Imjudo’s indications — Yervoy currently holds covered or better status for 66% of all insured lives under the pharmacy benefit, and 83% of lives under the medical benefit.
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.
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.
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.
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.
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.
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.
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.
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.