Health Plan Weekly

MCO Stock Performance, June 2022

Here’s how major health insurers’ stock performed in June 2022. UnitedHealth Group had the highest closing stock price among major commercial insurers as of June 30, 2022, at $513.63. Molina Healthcare, Inc. had the highest closing stock price among major Medicaid insurers at $279.61.

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© 2024 MMIT

How Can Pharma Incorporate the Commercial Aspect Into Drug Development?

When pharma companies launch a successful product, the process leading up to that point contains many key decisions from various teams across a manufacturer, including commercial. And with science leading to more and more innovations and many drugs coming to market via an accelerated process, it’s critical now more than ever to understand when to bring in the commercial team and how it can help with the development of a drug and its ultimate success in the market.

During a recent webinar, which was part of the Fierce Leaders in Sciences Forum sponsored by Fierce Pharma, moderator Lisa Johnson Pratt, a board member for Assembly Biosciences, kicked off the discussion by asking what the biggest challenges are for companies that are trying to bring a strong commercial point of view and input into the product development process.

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© 2024 MMIT

Behavioral Health Network Issues Lead to $4.6M Fine for Molina

Meeting Medicaid network adequacy requirements for behavioral health providers continues to be a challenge for health insurers, as shown by a recent $4.6 million settlement between Molina Healthcare, Inc., its former behavioral health subsidiary, Pathways of Massachusetts, and the Department of Justice.

In the case, Molina and Pathways of Massachusetts agreed to pay $4.625 million to resolve False Claims Act allegations that they submitted claims to MassHealth — the state’s Medicaid program — while violating regulations governing how staff are licensed and supervised, the U.S. Attorney’s Office for the District of Massachusetts said on June 21. The settlement in the case, which was first brought by four whistleblowers who were Pathways employees, calls for the former employees to receive $810,000.

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© 2024 MMIT

Plan Sponsors, Insurers Scramble to Adapt to Abortion Bans

After abortion suddenly became illegal in large swaths of the country following the Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization, the health benefits industry is scrambling to figure out whether and how to deliver abortion care to plan members. Chaos and uncertainty are the order of the day, and the upheaval is likely to continue as states consider new restrictions and penalties for administering, funding and being treated with abortions.

Overnight, health plans are being forced to contend with critical legal and operational issues relating to abortion. Plans with operations across states where abortion is legal and where it has been banned face unprecedented civil — and potentially criminal — liability for delivering benefits. At the same time, plan sponsors and carriers must figure out how to implement travel benefits for employees who reside in states where abortion is banned but are seeking abortion care in states where the procedure is legal (see infographic). And plans may be compelled to share health records relating to abortion benefits and reimbursement with law enforcement agencies prosecuting patients and providers involved in abortions.

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© 2024 MMIT

Fewer Abortion Facilities Accept Health Insurance, While Patients Face Higher Out-of-Pocket Expenses for Abortion

The proportion of open abortion facilities that accept any type of health insurance declined from 89% in 2017 to 80% in 2019 and 2020, while median patient self-pay charges for abortion are going up, according to a study published in Health Affairs in April. The South has the lowest percentage of health insurance acceptance, yet the Midwest saw the largest decrease over the four years, from 88% in 2017 to 75% in 2020.

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© 2024 MMIT

News Briefs: Supreme Court Limits Agencies’ Regulatory Authority

In its Thursday ruling striking down Environmental Protection Agency (EPA) emissions standards, the Supreme Court restricted the power of federal agencies across the government to issue regulations, legal experts say. The Supreme Court found that the EPA violated the “major-questions” doctrine, which according to SCOTUSblog is the legal doctrine “that if Congress wants to give an administrative agency the power to make ‘decisions of vast economic and political significance,’ it must say so clearly.” Attorney Katie Keith, a researcher at Georgetown University’s Center on Health Insurance Reforms, wrote on Twitter that the ruling is “a blockbuster.…beyond inhibiting federal efforts to mitigate climate change, it will be used to tie the hands of federal agencies (esp. on health issues) for years to come.”

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© 2024 MMIT

Centene Plans to Significantly Reduce Office Space; Other Insurers Likely to Follow

Centene Corp. revealed during its June 17 investor day that it plans to reduce by 65% the amount of office space it leases across the United States as a way to cut costs and appease employees who prefer working from home. Like many large employers, other health insurers have followed suit — or are considering doing so — as they adjust to an office environment that looks much different than was standard before COVID-19.

Several major insurance companies declined to discuss their office leasing plans when contacted this week by AIS Health, a division of MMIT. But most, if not all, are actively evaluating their real estate footprints, according to Dan Mendelson, the CEO of Morgan Health, JPMorgan Chase Co.’s health care arm.

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© 2024 MMIT

Colorado’s Ambitious Public Option Could Impact Employer-Backed Insurance Market

Colorado received permission from the Biden administration on June 23 to go ahead with the final element of its so-called “public option,” the Colorado Option. Experts tell AIS Health, a division of MMIT, that the program’s design is likely to deliver more premium savings than Washington state’s public option — and that the savings could make their way to the commercial market, especially if Individual Coverage Health Reimbursement Arrangements (ICHRAs) make further inroads in the Centennial State.

Experts tell AIS Health that the Colorado Option is innovative and could produce substantial premium savings, in large part because it has aggressive premium reduction goals. Starting in 2023, premiums for Colorado Option plans must be 5% lower than 2021 premiums, ultimately resulting in 15% cuts in premiums in 2025. After that, starting in "2026 and each year thereafter" premiums may increase "above the premium in the previous year by no more than medical inflation, relative to the previous year," per a summary of the law from the state legislature.

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© 2024 MMIT

News Briefs: Supreme Court Overturns Roe

The Supreme Court voted 6-3 to overturn the constitutional right to abortion established in Roe v. Wade. The ruling, released on Friday, will allow states to fully ban abortion without exceptions for rape, incest or the life of the mother. Experts predict that maternal mortality could increase by as much as 21% nationwide if abortion is banned nationally.

The Federal Trade Commission (FTC) ratcheted up regulatory pressure on PBMs once again, announcing that it will apply more scrutiny to PBMs' rebating practices, particularly regarding insulin. The move follows the agency's announcement earlier this month that it would investigate PBM business practices and consolidation. In an official policy statement, the agency wrote that “some have suggested that high rebates and fees to PBMs and other intermediaries may incentivize higher list prices for insulin” and that “rebate and fee agreements may incentivize PBMs and other intermediaries to steer patients to higher-cost drugs over less expensive alternatives.” Actions the agency said it would pursue include cracking down on exclusionary rebates and intensifying scrutiny of formulary design.

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© 2024 MMIT

In 2023, Purchasers to Seek Mental Health, Cost-Controlling Benefit Solutions

Grappling with rising premiums, a tough labor market and COVID-fueled health challenges, plan sponsors are focusing on key benefits as they prepare for the 2023 benefits cycle. That includes a concerted focus on behavioral health services and health equity, working to improve telehealth access and implementing strategies aimed at managing the total cost of care.

As adverse mental health conditions have increased sharply during the pandemic, behavioral health solutions, such as expanded access via network design and an expansion of virtual channels, figure to be prominent among purchasers’ needs, according to purchasing experts and benefits consultants interviewed by AIS Health.

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© 2024 MMIT