Approximately 2.4 million people enrolled in a Medicare Advantage plan from February 2020 to February 2021, bringing the total MA population to 26.3 million medical lives. That’s a 9.9% year-over-year increase, according to AIS Health’s analysis of data from the 2021 Medicare Annual Election Period (AEP). While the AEP was strong overall, the top 10 MA insurers continue to dominate the market, with 62.7% of all new enrollees selecting a plan from UnitedHealthcare, Humana Inc. or CVS Health Corp.’s Aetna. Meanwhile, Centene Corp.’s completed acquisition of WellCare Health Plans, Inc. allowed it to jump from No. 10 to No. 6, more than doubling its 2020 headcount.
Current Market Access to Chronic Heart Failure Medications
The FDA recently expanded the label of Novartis’ Entresto (sacubitril/valsartan) to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure. It became the first and only FDA-approved drug for both heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) in patients whose left ventricular ejection fraction (LVEF) is below normal levels.
Oncologists Expect to Prescribe New Renal Cell Carcinoma Drug
A Zitter Insights survey shows that the majority of oncologists are likely to prescribe a newly approved agent for advanced renal cell carcinoma.
Development of COVID-19 Vaccines, Tests, Therapeutics Could Have Broader Impact
The effort to develop therapeutics and vaccines to defend against COVID-19 has progressed at warp speed, if you will. As of March 8, 2021 — just over 13 months since then-HHS Secretary Alex Azar declared a public health emergency for the U.S. — the FDA already had given three vaccines, almost 10 drugs and biologics and 345 in vitro diagnostic tests Emergency Use Authorization (EUA). Industry experts suggest there are some lessons to be learned from the pandemic that the agency may leverage in the approval process overall.
FDA Approval Makes Breyanzi Third CAR-T Therapy in Non-Hodgkin’s Lymphoma
With the FDA’s approval of Bristol Myers Squibb’s (BMS) Breyanzi (lisocabtagene maraleucel) last month, there are now three chimeric antigen receptor T cell (CAR-T) therapies to treat a certain type of non-Hodgkin’s lymphoma (NHL). A Zitter Insights poll shows that payers do not anticipate its approval as having much of an impact on their management of the space. However, with more of these therapies in the pipeline, payers should take a closer look at these products and their strategies to manage them, say industry experts.
As Authorized Generics Proliferate the Market, Their True Benefits Are Unclear
Pharmaceutical manufacturers likely will continue to turn to authorized generics — drugs produced by brand-name drugmakers without the brand label — as they face increased pushback against high drug prices, but payers and patients probably won’t see much benefit as a result, according to industry experts.
Pass-Through Rebate Models Must Demonstrate Value to Catch On
With the Trump administration’s rebate rule delayed and possibly slated for repeal by Democrats in Congress, major changes in how the PBM industry distributes rebate revenue will have to come from the private sector. While a notable minority of PBMs has adopted alternative rebate models, experts say that plan sponsors’ demand for such models is muted, as they still must demonstrate that they generate more value than traditional models.
Lives Changes Driven by COVID-19 as of January 2021
When the COVID-19 pandemic began in the U.S. in March 2020, the closures and disruptions that the virus brought to nearly every facet of life sparked concern about the impact on market access. Would there be major shifts in medical and pharmacy coverage, with millions of lives moving from commercial coverage to the ranks of uninsured? The actual effects on health insurance enrollment, however, were relatively muted. Wide swaths of the workforce transitioned more easily to remote work than was initially predicted. And even in some industries that did see significant economic impact, employers were able to furlough employees rather than laying them off, allowing workers to maintain coverage, while other enrollees opted to use COBRA to keep their insurance.
Current Market Access to PCSK9 Inhibitors
A federal appeals court on Feb. 11 rejected Amgen Inc.’s bid to resuscitate antibody patents for its PCSK9 inhibitor Repatha, a victory for Regeneron Pharmaceuticals, Inc. and Sanofi S.A., the manufacturers of Repatha’s only rival, Praluent. (Praluent was developed by both companies, but following a 2020 restructuring of their arrangement, Regeneron is now solely responsible for the drug in the U.S.). The judge in the case agreed with a lower court ruling that Amgen could not make patent claims over monoclonal antibodies without more thoroughly describing their molecular structure, a decision that could have wider implications for the pharmaceutical industry.
MMIT Payer Portrait: Anthem, Inc.
Anthem, Inc. is the second-largest health insurer in the U.S., serving more than 33 million lives nationwide. It is also the largest Blue Cross and Blue Shield affiliate, acting as a Blues licensee in 14 states. Anthem's in-house PBM unit, IngenioRx, manages most of its pharmacy benefits, though CVS Specialty Pharmacy serves as its specialty PBM vendor. Anthem also operates Anthem Behavioral Health, and completed an acquisition of Beacon Health Options, one of the largest independent providers of behavioral health services in the U.S., in May 2020.
