Datapoint

Datapoint: Centene Pledges Nearly $1B for Affordable Housing

Centene Corp. this week said it is pledging $900 million on a multiyear partnership with housing developer McCormack Baron Salazar to build affordable housing communities in eight states. Housing stability can have a big impact on health outcomes, prompting Centene, which largely serves low-income beneficiaries, to take action.  "This innovative partnership promises to accelerate the development of high-quality, affordable housing by providing early-stage funding at rates not available on the open market,” Centene CEO Sarah London said in a statement. “Centene and our local health plans will also have the opportunity to participate in community engagement to help ensure that new housing and onsite services have the greatest possible impact on the health of local residents, many of whom Centene serves." Centene is the largest managed Medicaid and CHIP insurer in the U.S., serving 10,676,348 members as of May 2024.

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Datapoint: CMS Extends Medicaid Redetermination Deadline

CMS on May 9 said it would allow states to complete their Medicaid eligibility redeterminations through June 30, 2025. The agency previously required states to finish the “unwinding” process by the end of 2024.  As of May 10, states and Washington, D.C., reported they had completed about three-quarters of their eligibility decisions, according to KFF. About 48.1 million people had their coverage renewed, while 21.9 million people were disenrolled and 24 million people had not found out about their status. KFF reported that 69% of people who were disenrolled had their coverage terminated for procedural reasons. There are 85,001,088 Medicaid beneficiaries across all programs nationwide as of May 2024, according to AIS’s Directory of Health Plans.

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Datapoint: Aetna Shut Out of Medicaid Contract Awards

The Kansas Dept. of Health and Environment announced on May 14 that three insurers were awarded managed Medicaid contracts from Jan. 1, 2025, through Dec. 31, 2027. The state selected two incumbents (Centene Corp.’s Sunflower Health Plan and UnitedHealthcare Community Plan) and one new organization (Elevance Health Inc.’s Healthy Blue) to serve its Medicaid program, which is known as KanCare. Healthy Blue is a collaboration between Blue Cross and Blue Shield of Kansas and Blue Cross and Blue Shield of Kansas City. CVS Health Corp.’s Aetna, which currently has a managed care contract in Kansas, was not chosen. Aetna currently serves 132,684 Kansas Medicaid beneficiaries, about 31% of the program.

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Datapoint: FDA Expands Otezla’s Psoriasis Label

The FDA last month expanded the patient population of Amgen Inc.’s Otezla (apremilast) to include the treatment of people between 6 and 17 years old and weighing at least 20 kg with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy. The agency first approved the phosphodiesterase 4 (PDE4) inhibitor on March 21, 2014. Dosing for the new patient population of the tablet is 30 mg twice daily for people weighing at least 50 kg; for those at least 20 kg and less than 50 kg, dosing is 20 mg twice daily. For the treatment of psoriasis, virtually all insured lives have covered or better access to Otezla. 48% of covered lives have preferred access to Otezla, largely with utilization management restrictions applied.

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Datapoint: Cigna, Oscar to End Small Group Partnership

Cigna and startup insurer Oscar Health are shuttering their co-branded small group business. The Cigna + Oscar plans will be discontinued at the end of 2024 as Oscar focuses on the individual market, Oscar CEO Mark Bertolini said on a May 7 call with investors. “We believe ICHRA [individual coverage health reimbursement arrangements] is the solution for small group and middle market, and we believe that that will be a much bigger opportunity and we want to focus on getting that right,” Bertolini said, adding that the two companies struggled to find a long-term future for Cigna + Oscar. The products served about 61,000 members as of the first quarter of 2024. While Cigna is one of the largest commercial risk-based insurers in the U.S., the Cigna + Oscar partnership makes up the majority of its small group presence. Cigna serves just 71,601 small group members.

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Datapoint: FDA Approves Pfizer’s Hemophilia B Treatment

The FDA on April 26 approved Pfizer Inc.’s Beqvez (fidanacogene elaparvovec-dzkt) as a prophylactic treatment for adults with moderate to severe hemophilia B. Beqvez could become the new standard of care for hemophilia B, since it can prevent serious bleeding for up to three years after one dose is administered. Per Pfizer’s press release on the approval, the current standard of care “requires regular intravenous infusions…often administered multiple times a week or multiple times a month.” Pfizer will price a single course of Beqvez at $3.5 million before patient assistance and rebates, according to press reports. Norstella’s Evaluate Pharma projects the drug will net $57 million in global sales this year, following its July launch, growing to $378 million by 2030.

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Datapoint: Sandoz Reaches Agreement With Amgen to Launch Prolia, Xgeva Biosimilars

Sandoz reached an agreement with Amgen Inc. resolving all patent litigation related to denosumab, Sandoz revealed April 30. The FDA approved Sandoz’s Jubbonti (denosumab-bbdz) and Wyost (denosumab-bbdz) on March 5 as biosimilar to and interchangeable with Amgen’s Prolia (denosumab) and Xgeva (denosumab) for all of their indications. They are the first FDA-approved denosumab biosimilars. The agreement will allow the agents to launch on May 31, 2025, or earlier “under certain circumstances if customary acceleration provisions are triggered.” Prolia was first approved in 2010 for the treatment of osteoporosis in postmenopausal women at high risk of bone fracture. For this indication, the injectable currently holds covered or better status for 94% of all insured lives under the medical benefit, and 69% of lives under the pharmacy benefit.

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Datapoint: Utilization Trend Fuels $80M Operating Loss for UCare

UCare, a large public-sector insurer in Minnesota, posted an $82.1 million operating loss for year-end 2023, according to a report in the Star Tribune. That’s a 75% decrease from 2022. Execs said the loss was fueled by increased utilization, plus the cost of GLP-1s and RSV vaccines, according to the Tribune. "The higher medical cost ... is the result of increased utilization in pharmacy cost from prior year, and increased utilization of outpatient specialty services due to deferrals of preventive and elective care as well as provider contractual rate increases,” UCare said in a regulatory filing. UCare currently serves 551,431 members, with about 65% enrolled in managed Medicaid, and 27% in Medicare Advantage.

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Datapoint: Medicaid Enrollment Down 10% After One Year of Redeterminations

An analysis released on May 2 from the Urban Institute found that Medicaid disenrollments exceeded projections in eight states as of November 2023: Arkansas, Idaho, Iowa, Montana, New Hampshire, Oklahoma, South Dakota and Texas. The report, which was funded by the Robert Wood Johnson Foundation, also found that disenrollments of children were higher than projected in 12 states: Alabama, Arkansas, Colorado, Florida, Georgia, Idaho, Iowa, Mississippi, Montana, Oklahoma, South Dakota and Texas. The Urban Institute had previously projected that enrollment in Medicaid and the Children’s Health Insurance Program would decline by nearly 15 million people between April 2023 and June 2024. Between April 2023 and April 2024, Medicaid enrollment declined 10.4% to 85.7 million lives, according to AIS’s Directory of Health Plans.

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Datapoint: Oscar Reports First Profit

Health insurance startup Oscar Health on May 7 reported $177.4 million in net income in the first quarter of 2024 — its first-ever profit. Revenue was up 46% year-over-year, reaching $2.1 billion, which execs attributed to membership gains, rate increases and lower risk-adjustment costs. Following the most recent Affordable Care Act open enrollment period, Oscar reports 1.45 million members, about a 50% increase from the fourth quarter of 2023, according to AIS’s Directory of Health Plans.

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