Infographics

Ivermectin for COVID Costs Insurers Millions Despite Lack of Clinical Evidence

Insurers have paid millions of dollars to cover the cost of anti-parasitic drug ivermectin as a COVID-19 treatment even though there is no evidence that it’s actually effective against the disease, according to a new JAMA study. By analyzing claims from December 2020 through March 2021, the researchers found that patients with private insurance spent, on average, $22.48 per ivermectin prescription with insurers reimbursing an average of $35.75, for a total cost of $58.23. Patients with Medicare Advantage spent an average of $13.78, while their health plans reimbursed $39.13, for a total average cost of $52.91 per script. The study also estimated that health plans paid $2.5 million for COVID-related ivermectin prescriptions just in the week of Aug. 13, 2021; extrapolating that over the course of a year, such spending could add up to $129.7 million.

0 Comments
© 2024 MMIT

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.

0 Comments
© 2024 MMIT

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.

0 Comments
© 2024 MMIT

MCO Stock Performance, December 2021

Here’s how major health insurers’ stock performed in December 2021.

0 Comments
© 2024 MMIT

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.

0 Comments
© 2024 MMIT

By the Numbers: National Health Insurance Market in December 2021

Although the pandemic-driven economic crisis led to a massive increase in unemployment, loss of commercial health coverage has not been as great as predicted, and enrollment has rebounded over the past year. Meanwhile, the launch of a special enrollment period for the federal health insurance exchange and the temporarily expanded premium subsidies in the individual market led to membership growth in managed Medicaid and exchange plans, according to AIS’s Directory of Health Plans. Among the top five Blue Cross Blue Shield plans, all but BCBS of Illinois saw enrollment increases compared with December 2020.

0 Comments
© 2024 MMIT

Nearly 13 Million Americans Skipped Prescription Drugs Due to Costs Before COVID

Almost 12.8 million adults delayed or did not get prescription drugs in 2018-19 due to costs, including about 3.8 million privately insured nonelderly adults and 2.3 million elderly Medicare beneficiaries, according to a study by the Robert Wood Johnson Foundation and Urban Institute based on 2018–19 data from the Medical Expenditure Panel Survey. About 9.5% of adults who were uninsured all year reported unmet prescription drug needs, compared with 4.9% of Medicare beneficiaries and 5.6% of nonelderly Medicaid enrollees. More than one-quarter of adults with Medicare and 5.3% of privately insured people spent more than 1% of their family incomes on out-of-pocket prescription drug costs. In November, the House of Representatives passed the Build Back Better Act, which includes provisions seeking to bring down drug costs, but the bill’s fate in the Senate is in peril.

0 Comments
© 2024 MMIT

2021 in Review: Top 25 Medicare Advantage Insurers Enroll Nearly 90% of Market

The top 25 Medicare Advantage insurers enroll a combined 24.3 million lives, or 87.8% of the national market, according to the December 2021 update to AIS’s Directory of Health Plans. That’s up from 21.4 million lives at year-end 2020. Among the large national insurers, Centene Corp. saw staggering growth of nearly 40%, fueled by the insurer’s significant 2021 market expansion, followed by Anthem, Inc. at 30.7%. Anthem completed its acquisition of InnovaCare Health’s MMM Holdings, the largest MA organization in Puerto Rico, in July 2021. Highmark Health and Molina Healthcare also completed deals that boosted their MA presence this year. Just one insurer in the top 25, Triple-S Management Corp., saw an enrollment loss, though it was less than 1%. See the complete list in the table below.

0 Comments
© 2024 MMIT

Use of New Cancer Drugs Without Documented Clinical Benefit Substantially Increases

A growing share of patients have been prescribed oral targeted cancer drugs without documented overall survival (OS) benefit — from 12.7% in 2011 to 58.8% in 2018, according to a JAMA study, which analyzed dispensing claims for oral cancer drugs first approved by the FDA between Jan. 1, 2011, and Dec. 31, 2018. Cumulative spending on all 44 sample drugs reached $3.5 billion by the end of 2018, and 96.8% of that spending was on drugs approved based on a pivotal randomized clinical trial (RCT). Meanwhile, cumulative spending on drugs without documented OS benefit surpassed that on drugs with a documented benefit by the end of 2018. Among the top 20 drugs by spending amounts in 2018, one drug lacked a pivotal RCT and 13 drugs had no documented OS evidence at the time.

0 Comments
© 2024 MMIT

Employer Plans in 2021: Premiums, Telemedicine Coverage Rise

The average annual premium for employer-sponsored health insurance increased 4% to $7,739 for single coverage and $22,221 for family coverage, respectively, this year, according to the Kaiser Family Foundation 2021 Employer Health Benefits Survey. In recent years, high-deductible plans with a savings option have been gaining popularity. About 22% of firms offered an HDHP/SO and 28% of covered workers were enrolled in such a plan in 2021, representing slight declines compared with previous years. Meanwhile, the COVID-19 pandemic has increased the use of telemedicine, as 95% of firms with 50 or more workers offered telemedicine coverage in their largest health plan, up from 85% last year. In addition, about 65% of firms with 50 or more workers made changes to enhance their telemedicine benefits after the beginning of the pandemic.

0 Comments
© 2024 MMIT