COVID

UnitedHealth Downplays Cost of Omicron, At-Home Tests

For health insurers, the new year has ushered in a mandate to cover at-home COVID-19 tests and a highly transmissible coronavirus variant that is making it clear the pandemic is far from over. During its recent conference call to discuss fourth-quarter 2021 financial results, UnitedHealth Group explained how its massive, integrated health care enterprise is responding to both challenges.

The Biden administration on Jan. 10 unveiled new guidance specifying that all group and individual health plans must reimburse members for eight free over-the-counter COVID tests per month without cost sharing. The administration also said it would allow insurers to cap test costs at $12 each if insurers set up in-network agreements with pharmacies/retail stores that allow members to access free tests directly, without filing for reimbursement.

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News Briefs: HHS Renews Public Health Emergency | Jan. 21, 2022

HHS Sec. Xavier Becerra renewed the COVID-19 pandemic public health emergency until April 16, extending the PHE that was first announced on Jan. 31, 2020, by then-HHS Sec. Alex Azar into its third year. The PHE declaration makes possible enhanced Medicaid funding — in exchange for states pausing eligibility redeterminations — and expanded telehealth flexibilities for Medicare and Medicaid beneficiaries.

New insurer entry into the Affordable Care Act (ACA) exchanges is slowing down after several boom years, according to a new Robert Wood Johnson Foundation report. “While the total number of plan offerings increased by about one third between 2020 and 2021 (from 10,289 to 13,596), this year’s increase to 15,638 constitutes growth of about 15 percent,” wrote Katherine Hempstead, Ph.D., senior policy adviser for the foundation.

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As Omicron Surges, U.S. Struggles With Booster Rate

On Jan. 10, the U.S. reported 1.35 million new coronavirus cases as the highly contagious Omicron variant swept across the nation, breaking the previous daily record of 1.03 million. While a COVID-19 vaccine booster could increase immune response, the Centers for Disease Control and Prevention’s data show that only 36.7% of fully vaccinated people have received a booster dose nationwide, as of Jan. 11, 2022. Doubling the pace of booster vaccinations per day could prevent more than 41,000 deaths and 400,000 hospitalizations by the end of April, according to a recent analysis by The Commonwealth Fund.

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As Medicaid Enrollment Soars, States Ask MCOs to Intensify Social Determinants of Health Efforts

States are moving to better address social determinants of health (SDOH) and improve health equity in their Medicaid programs, and they’re asking MCOs to drive the change, according to an analysis of recent requests for proposals (RFPs) from advocacy group Together for Better Medicaid. The report identified RFPs from 10 states that have extensive SDOH and equity-based requirements for MCOs, from member screenings and staff training to close collaboration with community-based organizations (CBOs). Meanwhile, Medicaid enrollment has surged in all 10 states amid the COVID-19 pandemic. National Medicaid enrollment climbed 18.4% from March 2020 to December 2021, according to AIS’s Directory of Health Plans. See an overview of the most common SDOH requirements and the 10 states’ recent enrollment patterns below.

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Experts, Insurers Sound Off About COVID Test Payment Guidance

The Biden administration on Jan. 10 issued much-anticipated details about its new requirements for private health plans to pay for at-home COVID-19 tests, sparking immediate questions from industry observers and insurer trade groups alike about whether this is the right way to go about expanding testing access.

“We absolutely agree that a comprehensive national testing strategy is desperately needed and overdue,” says Ceci Connolly, president and CEO of the Alliance of Community Health Plans (ACHP). Members of the organization representing nonprofit health plans have been covering physician-ordered, lab-based tests — as required by pandemic relief legislation — throughout the public health emergency, she tells AIS Health, a division of MMIT. “Unfortunately, this approach runs the risk of confusing a lot of people, frustrating people who probably have trouble getting tests and probably not reaching the target audiences. So it misses the mark.”

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Notable 2021 Approvals Included Oncolytics, Interchangeables

Between the FDA’s Center for Drug Evaluation and Research (CDER) and its Center for Biologics Evaluation and Research (CBER), the agency approved 60 new products in 2021, including biologics, cell and gene therapies, vaccines and blood products. As the COVID-19 pandemic continued for the second year, much of the pharma industry’s focus, understandably, was on vaccines and therapeutics for the coronavirus. As with prior years, oncology dominated the specialty drug space, but the FDA also approved novel treatments in other areas as manufacturers continued to pursue innovative new products. Moreover, the U.S. saw the first two interchangeable biosimilars gain approval. AIS Health, a division of MMIT, spoke with various industry experts about what they considered the most notable FDA approvals in 2021.

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Specialty Pharmacy, Home Infusion Spaces Saw Myriad 2021 Changes

While the COVID-19 pandemic continued to impact the specialty pharmacy and home infusion spaces for the second straight year, other events also played a role. AIS Health spoke to some industry experts about 2021’s impact.

AIS Health: Looking back over the past year, what do you think were the most noteworthy occurrences within the specialty pharmacy industry, and why?

Dea Belazi, Pharm.D., M.P.H., president and CEO of AscellaHealth: Some of the noteworthy trends in SP have included the continued rise of the cost of specialty agents within health care expenditures, the continued emergence of ultra-high-cost specialty agents for rare and orphan diseases and the continued vertical integration of specialty pharmacies into health care organizations.

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As Omicron Surges, U.S. Struggles With Booster Rate

On Jan. 10, the U.S. reported 1.35 million new coronavirus cases as the highly contagious Omicron variant swept across the nation, breaking the previous daily record of 1.03 million. While a COVID-19 vaccine booster could increase immune response, the Centers for Disease Control and Prevention’s data show that only 36.7% of fully vaccinated people have received a booster dose nationwide, as of Jan. 11, 2022. Doubling the pace of booster vaccinations per day could prevent more than 41,000 deaths and 400,000 hospitalizations by the end of April, according to a recent analysis by The Commonwealth Fund.

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Looking Forward to 2022, COVID-19 Will Continue to Impact Pharma in Myriad Ways

As 2021 began, the pharmaceutical topic arguably drawing the most attention was COVID-19 and the rollout of vaccines against it. Moving into 2022, the COVID pandemic unfortunately continues to dominate headlines, as the U.S. marked 1 million new cases of COVID on Jan. 3, a single-day record for any country. However, it’s not all bad news, as the pandemic is continuing its impact across various services. For example, drugmakers are applying knowledge gained in their innovative efforts to develop vaccines and treatments to other areas of drug development, and a shift to virtual operations and health care is expected to continue.

AIS Health spoke with a variety of industry experts about their 2022 projections for pharma.

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News Briefs: Biden Promises to Deliver Free At-Home COVID Tests | Dec. 23, 2021

On the heels of announcing that private health insurers will soon have to reimburse Americans for at-home COVID-19 tests, President Joe Biden said on Dec. 21 that the federal government will also distribute a half-billion free at-home tests. During the president’s remarks, which come as case counts are rising due to the omicron variant, he acknowledged that “we need to do better with at-home testing,” adding that the administration will set up “websites where you can get them delivered to your home.” Biden also said the federal government will set up emergency testing sites in areas that need additional testing capacity, starting with sites in New York City.

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