News Briefs

News Briefs: Biden Admin. Likely to Extend PHE

Biden administration officials confirmed that they would extend the COVID-19 public health emergency (PHE) past July 15, when it is currently set to expire, according to press reports, though HHS Sec. Xavier Becerra has not yet issued an official proclamation to that effect. The administration has promised states that it will give them at least 60 days’ notice before the end of the emergency, in part to assist state officials as they restart Medicaid eligibility redeterminations. The PHE also allows for certain flexibilities in areas including telehealth practice. According to news reports, the PHE is likely to be extended until at least Oct. 13.

Nationally, commercial health plans pay 224% more than Medicare rates for services at hospitals, according to new research from the RAND Corp. The study is the latest in a series on hospital prices; the last installment came in 2018. Relative prices vary widely from state to state, with some states’ plans reimbursing below 175% of Medicare rates and some seeing rates of 310% or higher. The study also found that “a large portion of price variation is explained by hospital market power.”

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News Briefs: Second WCAS-Humana Joint Venture Will Deploy $1.2 Billion for Primary Care Clinics

Humana Inc. on May 16 said it had established a second joint venture with Welsh, Carson, Anderson & Stowe (WCAS) to further expand its value-based primary care clinics. (Hg Capital Partners and WCAS share control of MMIT, the parent of AIS Health.) The new JV will provide up to $1.2 billion of additional capital for the development of approximately 100 new CenterWell Senior Primary Care Clinics between 2023 and 2025, said Humana. The expansion follows an earlier JV that is currently deploying up to $800 million of capital to open 67 clinics by early 2023 and support their ongoing operations, added the insurer. WCAS will have majority ownership of the JV, while Humana will own a minority stake.

News Briefs: Oscar Leaves Arkansas, Colorado

Oscar Health, Inc. will cease operations in Arkansas and Colorado at the end of this plan year. Chief Financial Officer Scott Blackley defended the decision by saying “they’re really small” markets for the firm in response to a question from Goldman Sachs analyst Nathan Rich during the startup insurer’s latest earnings call, according to the Motley Fool. He added that “they don’t have a significant or even close to material effect [on profits.] There is a benefit though from just reducing…compliance work.” The firm has yet to post a profit, prompting criticism from managed care insiders.

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News Briefs: TG Therapeutics Withdraws Pending Applications for Ublituximab/Ukoniq Combo

TG Therapeutics, Inc. said April 15 that it voluntarily withdrew its pending Biologics License Application (BLA)/supplemental New Drug Application (sNDA) for the combination of ublituximab and Ukoniq (umbralisib) for the treatment of adults with chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma. The company said it made the decision based on updated overall survival data from the UNITY-CLL Phase III trial. The company also said that it voluntarily withdrew Ukoniq from sale for two indications: (1) for adults with marginal zone lymphoma who have received at least one anti-CD20-based regimen, and (2) for adults with follicular lymphoma who have received at least three prior systemic therapies. The FDA gave the drug accelerated approval for those indications on Feb. 5, 2021. On Feb. 3, 2022, the company disclosed that the FDA was investigating a possible increased risk of death with Ukoniq based on initial findings from the UNITY clinical trial. The FDA had scheduled an April 22 meeting to discuss the sNDA for the combination therapy, as well as Ukoniq’s accelerated approvals. Following TG Therapeutics’ withdrawal of the BLA/sNDA and Ukoniq’s existing indications, the agency cancelled the meeting. The FDA is expected to make a decision on the BLA for ublituximab in relapsing forms of multiple sclerosis by Sept. 28, 2022.

News Briefs: UnitedHealthcare to Restrict Aduhelm Access

UnitedHealthcare will restrict access to Aduhelm (aducanumab) across all of its books of business, arguing that “Aduhelm is unproven and not medically necessary for the treatment of Alzheimer’s disease due to insufficient evidence of efficacy,” according to company documents obtained by Stat News. The decision from the insurance branch of UnitedHealth Group, the largest private carrier in the country, follows a controversial move by CMS to restrict access to the drug mainly to patients who are participating in clinical trials. In a National Coverage Determination, CMS said the Medicare program will cover Biogen Inc.’s Aduhelm only for patients enrolled in randomized, controlled clinical trials conducted either through the FDA or the National Institutes of Health. For Medicare patients to be prescribed Aduhelm, they also must have a clinical diagnosis of mild cognitive impairment due to Alzheimer’s disease or mild dementia with a confirmed presence of plaque on the brain.

News Briefs: Centene Will Sell Off Two PBM Assets

As part of its PBM restructuring efforts, Centene Corp. will sell two pharmacy benefits subsidiaries, Magellan Rx and PANTHERx, for approximately $2.8 billion in separate deals. Magellan Rx will be sold to Blue Cross and Blue Shield affiliate-owned PBM Prime Therapeutics for $1.35 billion, while specialty pharmacy PANTHERx will be sold to a group of private equity firms that includes The Vistria Group, General Atlantic and Nautic Partners for $1.45 billion. Both prices are preliminary and the deals must undergo antitrust review. The PANTHERx sale “is expected to close in the next two to four months,” according to a Centene press release, while Magellan Rx “is expected to close in the fourth quarter of 2022.” Centene executives have sought to sell the firm’s PBM assets for some time; new CEO Sarah London said in February that the firm planned to “reduce our three PBM platforms down to one and to focus...[on] clinical member and provider engagement.” After the deals, Centene will retain PBM Envolve Health, presumably to fulfill those functions. Meanwhile, Centene has spent millions to settle claims by state Medicaid programs that it overcharged them for prescription drugs.

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News Briefs: New CMS Report Finds Non-White Medicare Advantage Enrollees Continue to Receive Worse Care

A new report looking at disparities in care for Medicare Advantage beneficiaries by race, ethnicity and sex found that non-white MA enrollees generally received worse care in 2020 than their white counterparts. Racial and ethnic differences were more glaring for clinical care measures than for patient experience measures, with scores for Black MA enrollees falling below the national average for 14 out of 36 clinical care measures, according to the April report, which was prepared by The RAND Corp. for the CMS Office of Minority Health. Researchers relied on Consumer Assessment of Healthcare Providers and Systems (CAHPS) data collected from March to May 2021 and the Healthcare Effectiveness Data and Information Set reflecting care received from January to December 2020. White enrollees reported care that was in line with the national average on all patient experience measures from the CAHPS survey, while their scores were similar to the national average on 31 clinical care measures and above average on five measures. Scores for American Indian and Alaska Native MA enrollees were also below the national average on 14 clinical care measures, and scores for Hispanic MA beneficiaries were worse than average on 11 such measures.

News Briefs: CMS Finalizes Rule Mandating Standard ACA Exchange Plans

CMS on April 28 finalized the 2023 Notice of Benefit and Payment Parameters for Affordable Care Act exchange plans, cementing its proposal to require insurers to offer standardized plans on HealthCare.gov. In a provision opposed by the insurance industry at large, the Biden administration will require issuers offering Qualified Health Plans (QHPs) on the federal exchange to offer standardized plan options at every network type, at every metal level and throughout every service area where non-standardized options are offered, starting in 2023. Those plans also will be differentially displayed on HealthCare.gov “to help consumers make more informed choices about their coverage.” Another major provision included in the annual omnibus rule governing the ACA exchanges is the addition of new network adequacy standards that require QHPs to “ensure that certain classes of providers are available within required time and distance parameters.”

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News Briefs: Humana Wins in Rite Aid Reimbursement Dispute

AllianceRx Walgreens Prime — a specialty and home delivery pharmacy business owned by Walgreens Boots Alliance — is rebranding to AllianceRx Walgreens Pharmacy. The move comes after Walgreens assumed full ownership of the business; previously, it was a joint venture between Walgreens and the PBM Prime Therapeutics. In addition to the company’s name change, it promoted Tracey James, R.Ph., from the role of senior vice president to chief operating officer.

Rite Aid Corp. must pay Humana Inc. $123 million after an arbitrator found that the retail pharmacy chain inflated reimbursement claims above the “usual and customary” prices for drugs, Stat reported. Rite Aid’s rival Walgreens Boots Alliance Inc. faces a similar lawsuit brought by several Blue Cross and Blue Shield affiliates. In both cases, the payers allege that the pharmacy chain systematically charged the health plans inflated prices for generic prescription fills. The health plans claim that their contracts with the pharmacies entitled them to reimburse the pharmacies for drug fills at the lowest price that the pharmacies charged for the drug in question, an arrangement called “usual and customary” pricing. However, the health plans say that the pharmacies charged cash-paying customers less than the “usual and customary” price submitted to health plans for reimbursement. Rite Aid plans to ask a federal court to vacate the arbitrator’s decision in the Humana case, per Stat, while the Walgreens-Blues suit is pending.

News Briefs: Humana Will Divest Kindred Divisions

Humana Inc. will spin off subsidiary Kindred at Home’s hospice and personal care divisions, with private equity fund Clayton, Dubilier & Rice taking majority ownership in exchange for $2.8 billion cash. Humana will retain a minority share in the new hospice company, which the deal values at $3.4 billion. David Causby, president and CEO of the divisions in question, will lead the new firm. “We are excited by the new strategic partnership structure with Humana and look forward to working closely with CD&R to pursue growth,” said Causby.

Former CMS Administrator Leslie Norwalk resigned from Centene Corp.’s board, citing “the governance process surrounding a recent important decision.” Norwalk in her resignation letter said that process “fell egregiously short of what I and a number of other Board members considered appropriate for making an informed decision.” Norwalk added that the board did not debate the move in question. Her resignation comes shortly after the death of longtime CEO Michael Neidorff, whom Sarah London replaced in March.

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