Consumer Engagement

Study: Pharma Companies Often Profit From Donations to Patient Assistance Charities

Pharmaceutical companies often profit from their donations to non-profit patient assistance charities that are intended to help people afford high-cost medications, according to a study published in this month’s edition of the journal Health Affairs.

HHS’s Office of Inspector General (OIG) has provided guidance on the charities and cracked down in recent years on several charities and drug manufacturers. However, the authors noted that “the current regulations or enforcement permit donations that violate the spirit of Medicare’s Anti-Kickback Statute,” which prohibits pharma companies from covering Medicare Advantage enrollees’ out-of-pocket drug spending for the drugs they manufacture.

Payers May Restrict Coverage of New Fast-Acting Oral Drug for Major Depression

The FDA on Aug. 19 approved the first and only rapid-acting oral drug for major depressive disorder (MDD), a treatment that is being hailed by its manufacturer as a “potential game-changer” for people struggling with the difficult-to-treat condition.

One pharma analyst expressed optimism about the drug’s ability to disrupt the MDD treatment market. However, experts from the PBM sector predict that payers may not embrace the drug warmly given how many generics are available to treat depression.

CivicaScript Launches Initial Generic Drug, Plans Several More in Coming Years

CivicaScript last week began selling its initial generic drug, a 250 mg abiraterone acetate tablet. It’s the first of what the health insurer- and PBM-backed nonprofit company hopes are many medications that it will produce to help patients and payers lower their drug spending.

The product is currently only available through Intermountain Healthcare, a Utah-based integrated health plan and system that owns a specialty pharmacy, and Lumicera Health Services, a specialty pharmacy owned by Navitus Health Solutions. But CivicaScript President Gina Guinasso tells AIS Health, a division of MMIT, that she expects other pharmacies to offer the medication in the coming months.

Pharmacist Care Managers Could Help Improve Diabetes Outcomes

Pharmacists and other non-physician care managers can improve the quality of diabetes care in the primary care setting, but structural issues make it difficult to fully leverage their potential, according to research published in the July issue of the journal Health Affairs.

“We need to have a different way of taking care of people with a chronic illness,” said Thomas Bodenheimer, a professor emeritus of family and community medicine at the University of California, San Francisco, who spoke at a Health Affairs briefing on July 19. The briefing convened several researchers who published diabetes-focused articles in the journal’s July issue.

Plans Build Trust, Mine Data to Dash Medication Adherence Barriers

When it comes to medication adherence rates, disparities among racial and ethnic groups pose a common challenge to health plans. But leaders in the Medicare Advantage space are working to disrupt the status quo with patient-centric, data-driven solutions that are helping to bridge the gap.

A recent initiative at SCAN Health Plan, a not-for-profit insurer serving 270,000 MA members in Arizona, California and Nevada, sought to narrow the gap between member groups by engaging in a top-down endeavor that wrapped in multiple departments, from human resources to pharmacy. “Our goal was to improve adherence,” relays Romilla Batra, M.D., chief medical officer with SCAN, “and to reduce gaps among African American and Latinx [members].”

Kaiser Permanente, in No-Bid Deal, Will Take Members From California MCOs

California elected officials approved a controversial plan that will enroll members of Medi-Cal, the state’s Medicaid program, in Kaiser Permanente’s MCO — shifting those same enrollees off the books of the insurers that currently claim them as members. That’s despite the vociferous objections of 16 county-run MCO plans, which stand to lose hundreds of thousands of members in the transfer to Kaiser Permanente, according to the CEO of the largest plan involved.

Kaiser Permanente did not have to participate in the normal Medi-Cal MCO bidding process to strike the deal. Instead, the integrated health system and insurer, which is based in Oakland, worked directly with the office of Democratic Gov. Gavin Newsom to develop a bill, Assembly Bill No. 2724 (A.B. 2724), authorizing the no-bid contract. State legislators approved the bill on June 29, with the lower chamber, the Assembly, voting 48-15 in favor and the Senate approving the deal 25-7.

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Plans Should Strive for ‘Seamless’ Digital Engagement

Health insurers have ramped up their use of digital tools to improve customer satisfaction, but still have more work to do — particularly as utilization returns to normal two years after the pandemic’s start. Customer satisfaction is lagging after several years of improving scores, and digital tools are disappointing some enrollees.

J.D. Power’s 2022 U.S. Commercial Member Health Plan Study identified call center customer support and digital tools as “key areas in need of improvement,” the advisory firm said May 26. “Health plan members expect a personalized, hands-on experience when dealing with customer support and they expect a seamless digital experience when engaging online. Health plans have some work to do to get the formulas right,” said Christopher Lis, managing director, global healthcare intelligence at J.D. Power.

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News Briefs: Consulting Firm Sold

Health care consulting firm Avalere Health has been sold to Fishawack Health, by previous owner Inovalon Health. In a letter to clients disclosing the deal, Avalere President Elizabeth Carpenter said that Avalere would “retain our logo and brand,” and “your client teams will remain the same and there will be no change to your current business relationship with Avalere. Everyone you know and love from Avalere is joining Fishawack, including all of our practice leadership.”

A new report by the Government Accountability Office (GAO) found that little information is available about the role that short-term health plans played during the COVID-19 pandemic — and that state regulators are not watching the industry closely. Short-term health plans are not required to meet all the standard benefits mandated by the Affordable Care Act. Per the report, “GAO found that limited and inconsistent data hinder understanding of the role short-term plans played during the COVID-19 pandemic for those who lost [employer-sponsored insurance], such as whether they were used by consumers as temporary coverage or as a longer-term alternative to ACA-compliant plans….State officials in the five states with plan sales were not able to report on the role of short-term plans for consumers, as none of them collected data on the duration of short-term plan coverage.”

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State Medicaid Agencies Grapple With Moving PHE End Date

With the COVID-19 public health emergency presumably continuing into October, state Medicaid agencies and their partners theoretically have more time to communicate with enrollees and prepare for the inevitable resumption of eligibility redeterminations once the PHE ends. But ongoing uncertainty over the PHE’s end date presents a host of challenges for states as they handle unprecedented numbers of Medicaid enrollees and attempt to conduct other program work unrelated to redeterminations, according to officials from California, Iowa and North Carolina who spoke during a May 24 webinar hosted by the National Association of Medicaid Directors (NAMD).

Throughout the PHE, which was declared in January 2020 and first renewed that April, states have received a temporary 6.2 percentage-point increase in their Federal Medical Assistance Percentage (FMAP) in exchange for maintaining continuous enrollment of nearly all Medicaid recipients. Once the PHE ends, states have 12 months to initiate eligibility reverifications for everyone enrolled in Medicaid and CHIP and 14 months overall to complete redetermination efforts.

News Briefs: Consumer Satisfaction With Plans Hits Roadblocks

While health insurers have made gains in consumer satisfaction in recent years, that progress stalled over the last year, according to a new report from J.D. Power & Associates. “Overall satisfaction has increased…during the past five years, but there is no change in 2022 from 2021, due in part to declines in satisfaction in customer service and dissatisfaction with coverage options and desired network providers,” a J.D. Power press release said. The report said that the health plans that members call “responsive” and “innovative” received the best satisfaction scores. Members also critiqued long hold times at call centers and have found decreasing satisfaction from electronic contact tools like texting and mobile apps. The highest scores for health plans, which were separated by region, were awarded to Kaiser Permanente, Humana Inc., Anthem, Inc., Geisinger Health Plan and several Blue Cross Blue Shield affiliates.

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