Data & Analytics

MMIT Reality Check on Schizophrenia (September 2022)

A review of market access for schizophrenia treatments shows that under the pharmacy benefit, about 26% of the lives under commercial formularies are covered with utilization management restrictions. Around 17% of the lives under Medicare formularies are not covered for at least one of the drugs.

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Report Shows Limited Access to Opioid Use Disorder Treatments for Medicare Beneficiaries

More than 50,000 Medicare Part D beneficiaries experienced an opioid overdose in 2021, while almost a quarter of Part D enrollees (12.1 million) received at least one prescription opioid through Medicare, according to a recent report from the HHS Office of Inspector General.

The proportion of beneficiaries receiving opioids has been declining, from 33% in 2016 to 23% in 2021. Alabama saw the highest proportion of opioid recipients (36%), while New York and Hawaii ranked the lowest (15%).

MMIT Reality Check on Acute Migraine (September 2022)

A review of market access for acute migraine treatments shows that under the pharmacy benefit, about 47% of the lives under commercial formularies are covered with utilization management restrictions. Around 49% of the lives under health exchange formularies are not covered for at least one of the drugs.

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Walmart, UnitedHealth Strike Latest Insurer-Retail Clinic Deal

Walmart Inc. and UnitedHealth Group will launch a co-branded Medicare Advantage plan in Georgia, license Optum-branded analytic and decision-making tools to existing Walmart Health clinics in 15 Florida and Georgia locations, and use Optum software to enable those Walmart clinics to enter value-based network agreements with MA plans.

One health care insider tells AIS Health that the move is further evidence of patients’ frustration with traditional, standalone clinics — and evidence that managed care firms are placing heavy bets on new types of providers to capitalize on that dissatisfaction.

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Key Financial Data for Leading Health Plans — Second Quarter 2022

Here’s how major U.S. health insurers performed financially in the second quarter of 2022. 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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MMIT Reality Check on Breast Cancer HR+/HER2- (September 2022)

A review of market access for treatments of adults with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) shows that under the pharmacy benefit, about 44% of the lives under commercial formularies are covered with utilization management restrictions. Around 33% of the lives under Medicare formularies are not covered for at least one of the drugs.

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MCO Stock Performance, August 2022

Here’s how major health insurers’ stock performed in August 2022. UnitedHealth Group had the highest closing stock price among major commercial insurers as of August 31, 2022, at $519.33. Humana Inc. had the highest closing stock price among major Medicare insurers at $481.78.

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Major National Health Insurers Expand ACA Presence in 2023

Cigna Corp. will expand its Affordable Care Act exchange offerings in 2023 by 50 new counties in Georgia, Mississippi and North Carolina and add three new states — Texas, Indiana and South Carolina — the insurer said in August. If approved by the state regulators, Cigna’s market expansion has the potential to reach roughly 730,000 additional enrollees. The carrier has been expanding its footprint over the past few years, currently ranking 11th in national ACA enrollment with 340,000 members. Its major state markets are Tennessee (85,000 members), Virginia (62,000) and Missouri (49,000).

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MMIT Reality Check on Non-Small Cell Lung Cancer Systemic Therapy (August 2022)

A review of market access for non-small cell lung cancer systemic therapy treatments shows that under the pharmacy benefit, about 38% 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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HHS Rule Takes Aim at Bias in Health Care Algorithms

While a recently proposed rule from HHS would mostly reinstate nondiscrimination protections that the Trump administration unwound, it also addresses an emerging issue that is likely to stir up controversy in the health insurance industry: bias in clinical algorithms.

The regulation, posted Aug. 4 in the Federal Register, would for the first time at the federal level prohibit a covered entity “from discriminating against any individual on the basis of race, color, national origin, sex, age, or disability through the use of clinical algorithms in decision-making,” explains a July 27 Health Affairs article summarizing the proposal. “Covered entities” include all health programs and activities receiving federal financial assistance, including health insurance issuers that get federal funding.

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