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Starting on April 12, Point32Health will not require utilization management for home care services for nearly all members in commercial plans during the first 30 days after discharge from a hospital. The insurer, whose affiliates are Harvard Pilgrim Health Care and Tufts Health Plan, announced the change in an April 2 press release. The company said it will continue to require prior authorization after the initial 30 days post-discharge for home care services, including physical therapy, occupational therapy, home health aides and nutritional counseling. Point32Health currently serves 668,575 commercial risk-based members in five New England states, plus an additional 636,785 members via self-funded arrangements.

Oklahoma’s transition to Medicaid managed care began April 1, according to a local ABC News station. The new program, SoonerSelect, replaces SoonerCare, the state’s fee-for-service system, for many Oklahomans. Beneficiaries were automatically enrolled in plans offered by CVS Health Corp.’s Aetna, Humana Inc. and Centene Corp., but have the option of switching to a new plan by June 30. Oklahoma currently serves 930,328 Medicaid and CHIP beneficiaries.

Kaiser Permanente on March 27 said it is partnering with investment firm Town Hall Ventures to launch new products under the Program of All-Inclusive Care for the Elderly (PACE) model. The new venture will be known as Habitat Health, and will begin serving seniors in Sacramento and Los Angeles in 2025, with a national expansion to follow. “We have an extraordinary challenge in this country,” Andy Slavitt, general partner with Town Hall Ventures, said in a statement. “The number of people age 85 and older in our country will double by 2040. We need a better answer for the millions of older adults that is more humane, compassionate, scalable, and affordable for the nation.” Just under 60,000 people nationwide are currently enrolled in PACE plans, with 14,898 residing in California. Leading the California market is AltaMed PACE, which serves 2,913 members as of March 2023.

CVS Health, Elevance Health and Kaiser Permanente said they will cover Novo Nordisk’s weight loss drug Wegovy (semaglutide) for its newly approved cardiac indications, according to a March 28 report in the Wall Street Journal. Wegovy can now be used in obese or overweight patients with cardiovascular disease at risk of cardiovascular death, heart attack and stroke. Medicare does not currently allow Part D plans to cover weight loss therapies, deeming them as cosmetic treatments, but CMS in the wake of Wegovy’s label expansion released guidance allowing plans to cover GLP-1s for cardiovascular indications. CVS's Aetna currently serves 8.15 million pharmacy lives under the Medicare channel, to Elevance’s 2.11 million. Kaiser, meanwhile, serves 1.84 million Medicare pharmacy lives.

The FDA last week granted full approval to AbbVie’s Elahere (mirvetuximab soravtansine-gynx) in certain ovarian cancer patients that have received up to three prior therapies. The antibody-drug conjugate received accelerated approval in November 2022. Phase 3 trial data for Elahere showed that the drug reduced the overall risk of cancer progression by 35%, leading to its full approval. Elahere currently holds covered or better status for 58% of all insured lives under the medical benefit.

The FDA on March 26 approved Merck’s Winrevair (sotatercept) — which the drugmaker netted from its $11.5 billion acquisition of Acceleron — for the treatment of pulmonary arterial hypertension (PAH). The rare disease causes high blood pressure and can lead to heart failure within a few years of diagnosis. Winrevair will be the first activin signaling inhibitor therapy in the PAH market basket, targeting the disease itself rather than managing symptoms. Evaluate Pharma estimates Winrevair will reach $1 billion in global sales by 2026. Among the most advantaged PAH therapies are Johnson & Johnson’s endothelin receptor agonist Opsumit, which holds covered or better status for 98% of all insured lives under the pharmacy benefit, and Uptravi, also from J&J. The rostacyclin receptor agonist holds 84% covered or better status under the pharmacy benefit.

Elevance Health Inc.’s CarelonRx PBM has agreed to acquire the Kroger Co.’s specialty pharmacy business, according to a March 18 press release. The deal is expected to close in the second half of this year and is subject to customary closing conditions. The companies did not disclose any financial details of the transaction, which does not include Kroger’s in-store retail pharmacies. Colleen Lindholz, president of Kroger Health, said in a statement that Kroger has owned its specialty pharmacy since 2012 and that “it became clear that our strong specialty pharmacy business unit will better meet its full potential outside of our business.” Elevance currently serves 11.85 million pharmacy lives across its insurance products.

More than 21 million people selected or were automatically reenrolled in health plans during the most recent Affordable Care Act open enrollment period (OEP). That’s according to one of four reports issued by HHS on March 22 marking the 10-year anniversary of the ACA. HHS also said that 5.1 million more people signed up for coverage during the 2024 OEP compared to the 2023 OEP, representing a 31% increase. The three largest exchange insurers as of the latest update to AIS Health’s Directory of Health Plans are Centene Corp. (3.6 million members), Florida Blue (1.2 million members) and Aetna (1.1 million members).

A weight loss pill could be Novo Nordisk’s next blockbuster, CEO Lars Fruergaard Jørgensen told CNBC. While the pill is still years away from approval, a midstage trial is planned for the second half of this year, and results are expected in 2026. Novo’s head of development told Reuters that the company expects to launch the drug, amycretin, sometime in the 2020s. Oral administration could be a major coup for Novo in the weight loss category: GLP-1s, currently the best drugs in the space, are injectables, which poses adherence and market access challenges compared to oral administration. Novo’s GLP-1 approved for weight loss, Wegovy, currently holds covered or better status for 53% of all insured lives, while Lilly’s new Zepbound stands at 31%.

CMS earlier this month gave Nevada the go-ahead to implement a pilot program that will provide housing and other supportive services to Medicaid beneficiaries in need, according to a report in the Nevada Current. The new Section 1115 waiver will allow Medicaid to cover up to six months of rent, temporary housing and utility payments, as well as meals for the duration of the housing period. The pilot will start with an estimated 20,300 beneficiaries, according to the news outlet. Nevada’s Medicaid program currently serves 807,545 beneficiaries, with 83.5% enrolled in managed care plans.