News Briefs

Humana Inc. has started to integrate Kindred at Home, a home care subsidiary that the payer acquired in summer 2021, into its CenterWell Home Health subsidiary. Clinics in seven states — Washington, Oregon, Idaho, Nevada, Arizona, New Mexico and North Carolina — will now become part of the CenterWell brand, “with other locations transitioning later this year,” per a press release. Eventually, the combined CenterWell brand will “support patients from more than 350 locations across 38 states.” The Hospice, Palliative, Community and Personal Care divisions of Kindred at Home are not part of the CenterWell Home Health rebranding.

CMS on Feb. 24 released plans to revamp the Global and Professional Direct Contracting model, which allows participants to share risk and receive capitated payments for serving fee-for-service Medicare beneficiaries. Democrats like Washington Rep. Pramila Jayapal and Massachusetts Sen. Elizabeth Warren have criticized the model for transforming “the care of a traditional Medicare beneficiary to care typically seen in a private Medicare Advantage (MA) plan despite the fact that the patient chose not to enroll in an MA plan,” in Jayapal’s words. However, in good news for insurers like Clover Health, which are counting heavily on direct contracting revenue, CMS appears to still allow health insurers to apply for the renamed ACO Realizing Equity, Access, and Community Health (REACH) Model. As part of the overhaul, CMS promised greater “participant vetting, monitoring and transparency,” more promotion of provider leadership and governance, and a larger focus on health equity, among other changes.

Health insurers and PBMs are paying pharmacies low rates — from one cent to $10 — for filling prescriptions of COVID-19 drugs Paxlovid and molnupiravir, The Wall Street Journal reports. Those fees often don’t cover the costs of filling prescriptions for the Pfizer Inc. and Merck & Co. drugs, pharmacists say, and thus some are refusing to stock the pills. The National Community Pharmacists Association is also lobbying CMS to recommend a $40 reimbursement rate for Paxlovid and molnupiravir, similar to what Medicare pays pharmacies for administering the COVID-19 vaccine, according to the article.

A Phase III clinical trial of AstraZeneca and Daiichi Sankyo drug Enhertu (trastuzumab deruxtecan) delivered promising results that could position the therapy to become a standard treatment for a large group of breast cancer patients. In a Feb. 21 press release, the drug companies reported that Enhertu prolonged survival and slowed the progression of metastatic breast cancer with low levels of a protein known as HER2. The improvement was “clinically meaningful” when compared with standard chemotherapy, and this is the first time such a therapy has shown a benefit in breast cancer patients who have low levels of HER2 expression — a group comprising 55% of all breast cancer patients — the drugmakers said.

The Dept. of Justice is preparing to file suit to block UnitedHealth Group’s proposed acquisition of Change Healthcare Inc., according to multiple media outlets citing Dealreporter. Reportedly, the DOJ will meet with UnitedHealth and Change Healthcare representatives in the next few days. The firms had looked into divesting assets to pass antitrust scrutiny, but the DOJ has not accepted any proposal so far, sources familiar with the transaction told Dealreporter.

AHIP asked CMS for more information regarding its National Coverage Determination (NCD) on Aduhelm, the controversial Alzheimer’s drug that garnered accelerated approval from the FDA in 2021 despite objections on scientific and ethical grounds. CMS said in January that Medicare will cover Aduhelm and other drugs in its class only for people who are enrolled in qualifying clinical trials. In a Feb. 10 letter signed by AHIP CEO Matthew Eyles, the trade group requested “that CMS provide clear guidance to MA plans on their coverage obligations under the NCD.” In particular, Eyles called for a list of clinical trials MA plans must cover.

Rhode Island Attorney General Peter Neronha, a Democrat, subpoenaed UnitedHealthcare over a recent data breach that saw the personal data of 22,000 plan beneficiaries get hacked by an unknown third party. The exposed beneficiaries were members of the health plan of the Rhode Island Public Transport Authority, which discovered the breach, Modern Healthcare reported.

The number of telehealth visits has declined as the pandemic has receded, according to analysis of Epic Systems Corp. data by the Kaiser Family Foundation. The research indicates telehealth visits accounted for 13% of outpatient visits between March and August 2020, but declined to 11% of outpatient visits between September 2020 and February 2021 and 8% of such visits from March to August.

Gilead Sciences, Inc. said on Jan. 14 that it is voluntarily withdrawing two indications for Zydelig (idelalisib): for the treatment of relapsed follicular B-cell non-Hodgkin lymphoma (FL) and small lymphocytic leukemia (SLL), both of which had accelerated approval. “As the treatment landscape for FL and SLL has evolved, enrollment into the confirmatory study has been an ongoing challenge,” said the company in a press release. Along with the FL and SLL approvals on July 23, 2014, the FDA granted traditional approval to the drug for the treatment of relapsed chronic lymphocytic leukemia. Zydelig will remain on the U.S. market for this indication.

Ramona Sequeira has become the new chair of the Pharmaceutical Research and Manufacturers of America (PhRMA) board of directors. She is the first woman to hold that top leadership position at the industry’s chief lobbying group. Sequeira is the president of Takeda Pharmaceuticals’ U.S. business unit and head of global portfolio commercialization at the Japanese drugmaker, per a Feb. 3 press release.

CMS on Feb. 2 released the 2023 preliminary rate notice for Medicare Advantage plans, giving plans an average pay boost of about 8%. To arrive at an expected average change in revenue of 7.98% for 2023, CMS factored in an effective growth rate of 4.75%, which is based largely on an anticipated rise in fee-for-service Medicare costs, according to a CMS fact sheet on the subject.

Medicare Part B beneficiaries will be able to acquire over-the-counter COVID-19 tests free of charge at participating pharmacies and retailers “starting in early spring,” according to CMS. Per a CMS fact sheet, beneficiaries will not need to apply for reimbursement to get the tests: “Eligible pharmacies and other entities that are participating in this initiative to allow Medicare beneficiaries to pick up tests at no cost at the point of sale and without needing to be reimbursed.” AHIP CEO Matt Eyles applauded the move. “This is a commendable model and the right path — for Medicare-eligible people and for all Americans — to ensure equitable access, swift treatment, and an effective response to the virus,” he said in a statement.

With the open enrollment period for 2022 Affordable Care Act exchange plans now over in most states, the Biden administration announced a record-breaking number of signups. A total of 14.5 million people enrolled in ACA marketplace coverage from Nov. 1, 2021, through Jan. 15, 2022, including 10.3 million people who live in states served by HealthCare.gov and 4.2 million in states with their own marketplace, CMS said. Enrollment remains open in the District of Columbia and five states — California, Kentucky, New Jersey, New York and Rhode Island — through Jan. 31.

The price of the average brand-name drug has increased by 18.3% annually on average over the last five years, according to research firm GlobalData. Floriane Reinaud, research and analysis director at GlobalData, said in a statement that this price growth is unique to the U.S. “While drug list prices have only been increasing in the US, major markets in the rest of the world are seeing declines. Japan, for example, saw drug prices decline by more than 9% while Germany declined by around 7.5%,” Reinaud said.

The business strength of “speculative grade” pharmaceutical companies varies considerably, mainly due to differences in their produce concentration and drug development pipelines, according to S&P Global Data. S&P analysts Patrick Bell and David A. Kaplan also wrote that “although speculative-grade companies are frequently more aggressive in pricing and life cycle management strategies, legislators and the media primarily focus criticism on well-known investment-grade peers and their more widely prescribed blockbuster drugs. Similarly, we believe pharmacy benefit managers place more attention on controlling spending on blockbuster drugs than those with narrower patient bases such as orphan drugs. Nevertheless, with a higher proportion of revenues generated in the U.S. and higher leverage, we believe drug price reform could hurt speculative-grade pharma companies disproportionately.”