Datapoint

Datapoint: Mississippi’s Latest Medicaid Expansion Effort Fails

Mississippi lawmakers on May 2 failed to send a final Medicaid expansion proposal to the state’s House and Senate after previously reaching an agreement April 29, according to a report in the Associated Press. Lt. Gov. Delbert Hosemann (R) told members of the press that revisiting Medicaid expansion will be a top priority in 2025. The original measure would have included a 25-hour-per-week work requirement. The state currently serves 763,997 Medicaid beneficiaries, with 63.5% enrolled in managed care plans. The New York Times estimated that an additional 200,000 people would become eligible for Medicaid under expansion.

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© 2024 MMIT

Datapoint: CVS Acquires MA Brokerage Platform

CVS Health has acquired startup Medicare Advantage broker Hella Health, according to a LinkedIn post from founder Rafal Walkiewicz. Hella Health aims to create an easier experience for seniors shopping for MA plans online. "Through this combination, CVS Health will expand its multi-payer technology platform to include a wide range of insurance offerings, supported by trusted advisors and agents, to provide a simple, direct-to-consumer Medicare shopping and enrollment experience," Walkiewicz wrote. CVS Health’s insurance arm, Aetna, already offers plans on the platform, alongside other large MA insurers. Aetna is currently the third largest MA insurer in the U.S., serving 4,137,068 members.

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Datapoint: Elevance Unveils New Specialty Drug Approach

CarelonRx, the PBM arm of Elevance Health, Inc., has a new “comprehensive approach to specialty medication savings across pharmacy and medical benefits,” according to an April 22 press release. The new product will use “advanced analytics” to “identify members whose health is at the greatest risk,” which will prompt “a thorough review of a member’s clinical diagnoses, medications, whole-health integrated support, and a review of their site of care options.” At that point, identified members will receive “proactive pharmacist-led outreach to address any barriers to care, and to further coordinate integrated care with their whole health team, including medical and behavioral health professionals.” Elevance currently serves 11,934,672 pharmacy lives across all insurance channels, according to data from AIS Health’s parent company, MMIT.

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© 2024 MMIT

Datapoint: Molina Plans for More M&A

Molina executives on an April 25 call to discuss first-quarter earnings revealed the company will continue to look for new merger and acquisition opportunities throughout the year. In 2023, Molina acquired Wisconsin Medicaid insurer My Choice Wisconsin, and picked up its first Medicare Advantage assets with its purchase of Bright Health’s MA business. The insurer currently ranks fourth in national managed Medicaid enrollment, serving 3,864,750 members. An additional 283,114 members are enrolled in MA products.

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Datapoint: Humana to Exit Some MA Markets

During an April 24 call to discuss first-quarter earnings, Humana executives revealed the company expects to exit some of its Medicare Advantage markets for the 2025 plan year. "We are anticipating net membership declines in 2025, largely because we do plan to exit certain plans and counties," Chief Financial Officer Susan Diamond said. "Whether that is incrementally larger or smaller based on the other plans will be very dependent on what we see across the competitive landscape." Humana is revisiting its 2025 earnings guidance following the release of CMS’s 2025 final rate notice, which cut benchmark payments and continues the phase-in of risk adjustment and coding changes. Diamond said the company expects to know which markets will be affected in June. Humana is currently the second-largest MA insurer in the U.S., serving 6.02 million members. Its largest markets are in Florida, Texas and North Carolina.

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Datapoint: Alvotech and Teva Plot Broader Simlandi Launch

Alvotech and Teva Pharmaceutical Industries Ltd. Signed a "long-term agreement” to bring its Simlandi (adalimumab) biosimilar to market with an undisclosed partner, according to press reports. In February, the FDA designated Simlandi as the first biosimilar to be interchangeable with Humira (adalimumab), the best-selling drug from AbbVie that treats a variety of autoimmune conditions. With an interchangeable status, a biosimilar can be substituted for a reference biologic by a pharmacist with a provider’s approval. Simlandi had previously struggled to gain FDA approval, making it a late entrant in the burgeoning Humira biosimilar field. Humira continues to hold covered or better status for 91% of all insured lives under the pharmacy benefit.

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Datapoint: Mississippi Could Create State-Based Exchange

Mississippi lawmakers last week introduced legislation that would establish a state-run health exchange, transitioning the state away from the federal marketplace. “If you have a state-based exchange, you can lower the cost of insurance for folks who buy off the exchange,” Mississippi Insurance Commissioner Mike Chaney told local news outlet WLBT. “We can lower premiums more. We can offer more options. We can do a lot of things to help preventive healthcare within the state, especially in the rural areas of the state. This is a good plan.” Just over 180,000 people are currently enrolled in exchange plans in Mississippi, with Centene Corp. leading the pack at 86% market share.

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Datapoint: FDA Approves Alvotech and Teva’s Stelara Biosimilar

The FDA last week approved Alvotech and Teva’s Stelara biosimilar Selarsdi (ustekinumab-aekn) for the treatment of moderate to severe plaque psoriasis and active psoriatic arthritis in adults and pediatric patients 6 years and older. The drugmakers said they plan to launch the drug, the second FDA-approved Stelara biosimilar behind Amgen’s Wezlana, in early 2025. For the treatment of psoriasis, Stelara currently holds covered or better status for 73% of all insured lives under the medical benefit. The biologic brought Johnson and Johnson $10.86 billion in global sales in 2023.

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Datapoint: Elevance to Take On Primary Care Expansion

Elevance Health, Inc. has struck an agreement with private equity firm Clayton, Dubilier & Rice (CDR) to increase its foothold in primary care across the United States. Elevance said in an April 15 press release that the deal will “bring together certain care delivery and enablement assets” of the company’s Carelon Health subsidiary and two CDR-owned companies: apree health and Millenium Physician Group. Elevance said the “advanced primary care models take a whole health approach to address the physical, social, and behavioral health of every person.” The deal is subject to customary regulatory approvals. Elevance’s health insurance unit currently serves 37,429,058 members, making it the second-largest insurer in the U.S.

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Datapoint: FDA Delays New Leqembi Launch

The launch of a new version of Eisai and Biogen’s Leqembi (lecanemab) has been delayed, with the FDA requesting additional information about the Alzheimer’s drug. The FDA wants more data about the effectiveness of subcutaneous injection relative to infusion, Leqembi’s current form of administration. Currently, Leqembi must be infused onsite in a clinical setting every two weeks. The drugmakers hope that a switch to biweekly injections will reduce the burden of administration for practitioners and speed adoption of the drug, which Eisai admits has been slower than hoped. For the treatment of Alzheimer’s disease, 38% of all insured lives have covered or better access to Leqembi under the medical benefit.

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© 2024 MMIT