Data & Analytics

MMIT Reality Check on Atopic Dermatitis

A review of market access for atopic dermatitis treatments shows that under the pharmacy benefit, about 31% of the lives under commercial formularies are covered with utilization management restrictions. Around 54% of the lives under Medicare formularies are not covered for at least one of the drugs.

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Medicaid Rolls Soar to Nearly 89 Million Beneficiaries as Redeterminations Loom

Nationwide Medicaid enrollment has grown more than 22% since the outset of the COVID-19 pandemic, topping 88.7 million lives, according to the latest update to AIS’s Directory of Health Plans. But the end of the Public Health Emergency (PHE) — which at press time was likely to be extended beyond mid-July — could leave between 5.3 million and 14.2 million people without coverage when redeterminations resume, asserted a May 10 analysis from the Kaiser Family Foundation. A separate study from the Georgetown University Heath Policy Institute found that 6.7 million children stand to lose CHIP coverage at the end of the PHE. See a state-by-state overview of three years of pandemic-fueled Medicaid enrollment changes in the chart below.

MMIT Reality Check on Narcolepsy

A review of market access for treatments for adults with narcolepsy shows that under the pharmacy benefit, about 58% of the lives under commercial formularies are covered with utilization management restrictions. Around 38% of the lives under Medicare formularies are not covered for at least one of the drugs.

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A Look at Third-Party Oncology Clinical Pathways

In order to improve patient outcomes and reduce variations in oncology care, more and more payers and providers are adopting oncology clinical pathways (OCPs) — treatment protocols that aim to provide the optimal cancer care to patients at the lowest cost, according to a recent MMIT webinar. The share of oncologists exposed to third-party oncology pathways increased from 20% in 2015 to 52% in 2021, with one third of oncologists choosing a provider-focused pathway as of the fourth quarter of 2021. Breast cancer, multiple myeloma and non-small cell lung cancer are among the top therapeutic areas managed by third-party pathways.

MMIT Reality Check on Hemophilia B (Factor IX)

A review of market access for hemophilia B (factor IX) treatments shows that under the pharmacy benefit, about 32% of the lives under commercial formularies are covered with utilization management restrictions. Around 18% of the lives under health exchange formularies are not covered for at least one of the drugs.

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MCO Stock Performance, April 2022

Here’s how major health insurers’ stock performed in April 2022. UnitedHealth Group had the highest closing stock price among major commercial insurers as of April 29, 2022, at $508.55. Molina Healthcare, Inc. had the highest closing stock price among major Medicaid insurers at $313.45.

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A Look at Third-Party Oncology Clinical Pathways

In order to improve patient outcomes and reduce variations in oncology care, more and more payers and providers are adopting oncology clinical pathways (OCPs) — treatment protocols that aim to provide the optimal cancer care to patients at the lowest cost, according to a recent MMIT webinar. The share of oncologists exposed to third-party oncology pathways increased from 20% in 2015 to 52% in 2021, with one third of oncologists choosing a provider-focused pathway as of the fourth quarter of 2021. Breast cancer, multiple myeloma and non-small cell lung cancer are among the top therapeutic areas managed by third-party pathways.

MMIT Reality Check on Anemia Due to Chronic Kidney Disease

A review of market access for treatments for adults with anemia due to chronic kidney disease shows that under the pharmacy benefit, about 37% of the lives under commercial formularies are covered with utilization management restrictions. Around 41% of the lives under Medicare formularies are not covered for at least one of the drugs.

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Key Financial Data for Leading Health Plans — Fourth Quarter 2021

Here’s how major U.S. health insurers performed financially in the fourth quarter of 2021. Health Plan Weekly subscribers can access more health plan financial data — including year-over-year comparisons of leading health plans’ net income, premium revenue, medical loss ratios and net margins. Just email support@aishealth.com to request spreadsheets for current and past quarters.

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A Look at Third-Party Oncology Clinical Pathways

In order to improve patient outcomes and reduce variations in oncology care, more and more payers and providers are adopting oncology clinical pathways (OCPs) — treatment protocols that aim to provide the optimal cancer care to patients at the lowest cost, according to a recent MMIT webinar. The share of oncologists exposed to third-party oncology pathways increased from 20% in 2015 to 52% in 2021, with one third of oncologists choosing a provider-focused pathway as of the fourth quarter of 2021. Breast cancer, multiple myeloma and non-small cell lung cancer are among the top therapeutic areas managed by third-party pathways.