AIS’s Directory of Health Plans

Health Care Service Corp. (HCSC), the parent org of five Blues affiliates in Illinois, Montana, New Mexico, Oklahoma and Texas, will expand its Medicare Advantage offerings to more than 150 new counties for the 2023 plan year. Focusing on rural and underserved counties, the move is HCSC’s largest-ever MA expansion, and will reach up to 1.1 million additional Medicare eligibles, per an Aug. 1 press release. HCSC’s five Blues subsidiaries currently serve 123,447 MA members, according to the latest update to AIS’s Directory of Health Plans.

UnitedHealth Group on July 15 said it will eliminate copays or out-of-pocket costs for select drugs, including insulin, epinephrine and albuterol, for members in its standard fully insured group plans. The company said it hopes the move will encourage greater medication adherence and reduce unnecessary health complications and/or hospitalizations. United currently enrolls 7,354,188 people in group risk-based plans, representing 15.9% of its overall membership.

Despite the availability of generic competitors, Bristol Myers Squibb posted Revlimid sales of $2.5 billion for the second quarter of 2022, beating out analyst expectations. BMS said in its earnings report it expects total Revlimid sales of $9.0 to $9.5 billion for the full year. Teva Pharmaceuticals launched Lenalidomide, the first Revlimid generic available in the U.S., in May. Other generic competitors are available internationally, and more copies are set to arrive in the U.S. later this year. For the treatment of multiple myeloma, Lenalidomide holds preferred generic status for 19% of all insured lives under the pharmacy benefit. Revlimid, meanwhile, is a preferred multiple myeloma drug for 52% of insured lives.

After originally exiting the marketplace in 2017, Blue Cross Blue Shield of Nebraska will return to the state’s ACA exchanges for the 2023 plan year. “Ever since we’ve gotten out, we’ve been analyzing, trying to figure out when is the right time to get back in. Now is the right time,” Executive Vice President Ron Rowe told the Omaha World-Herald July 22. The insurer will offer Nebraska HeartlandBlue in all 93 of the state’s counties. As of the first-quarter of 2022, four insurers currently participate in Nebraska’s exchanges: Medica (60,000 members); Bright Health (43,000 members); Centene Corp. (12,800 members); and Oscar Health (2,900 members).

Orange County, Calif.-based insurer CalOptima plans to enter California’s Affordable Care Act exchange marketplace, Covered California, for the 2024 plan year. The move will be decided by the Orange County Board of Supervisors in early August, according to a July 21 press release. Also per the press release, CalOptima insures about 25% of Orange County’s population via its Medicaid plans. CalOptima currently enrolls 884,979 beneficiaries in the Medicaid and dual eligible markets, according to the latest update to AIS’s Directory of Health Plans.

Somerville, Mass.-based AllWays Health Partners will rebrand to Mass General Brigham Health Plan, as of Jan. 1, 2023. The nonprofit insurer was acquired by Mass General Brigham, a large Boston-based health system, in 2012. The rebrand also represents a shift to value-based care, emphasizing flexibility and addressing social determinants of health. AllWays Health Partners currently enrolls 228,364 members in Massachusetts, with 37.2% enrolled in commercial risk-based plans, and 16.7% enrolled in managed Medicaid.

Molina Healthcare Inc. will acquire My Choice Wisconsin, a small Medicaid MCO based in Wauwatosa, Wis., for $150 million in cash. A July 13 press release from the insurer said that “the transaction is expected to be immediately accretive to Molina’s adjusted earnings per share” and will close later in 2022 pending regulatory review. My Choice Wisconsin’s health plan currently enrolls 28,226 fully insured Medicaid members.

Centene Corp. last week completed its sale of specialty pharmacy arm PANTHERx to Vistria Group, General Atlantic and Nautic Partners. Centene originally purchased the rare drug company in December 2020. The insurer said in a July 14 press release that it intends to use the windfall to “repurchase stock and the balance to reduce debt.” Centene is also in the process of selling Magellan Rx to Prime Therapeutics, with the two deals valued at $2.8 billion. Centene is currently the fourth-largest insurer in the U.S., with 20,988,628 members.

Startup insurer Clover Health will expand its Medicare Advantage presence in three states for the 2023 plan year; Georgia, South Carolina and Tennessee. The insurer also said it will leave two of its smaller markets, El Paso County in Texas and Pima County in Arizona. In a July 14 press release, Clover Health said it hopes its Georgia expansion replicates its previous success in New Jersey, by “significantly increasing the breadth and depth of its provider network throughout the state with the addition of dozens of hospitals, health systems and key provider partners across the region, aligning approximately 5,000 new primary care physicians and specialists.” Clover Health currently enrolls 84,948 MA members, with 82.7% enrolled in a New Jersey plan offering.

The state of Delaware this week awarded new Medicaid managed care contracts to three payers; incumbents Highmark Health and AmeriHealth Caritas, plus new entrant Centene Corp. "We are excited to work with the state and providers on proven models of value-based care to deliver transformative healthcare and improve the health of Diamond State Health enrollees across the state,” Brent Layton, president and chief operating officer with Centene, said in a July 12 press release. The new contracts, which are set to begin January 1, 2023, represent a shift to value-based care for the state. Delaware’s managed care plans currently serve 240,411 lives, representing 85.6% of the overall Medicaid population.