News Briefs

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.”

HHS Sec. Xavier Becerra renewed the COVID-19 pandemic public health emergency until April 16, extending the PHE that was first announced on Jan. 31, 2020, by then-HHS Sec. Alex Azar into its third year. The PHE declaration makes possible enhanced Medicaid funding — in exchange for states pausing eligibility redeterminations — and expanded telehealth flexibilities for Medicare and Medicaid beneficiaries.

New insurer entry into the Affordable Care Act (ACA) exchanges is slowing down after several boom years, according to a new Robert Wood Johnson Foundation report. “While the total number of plan offerings increased by about one third between 2020 and 2021 (from 10,289 to 13,596), this year’s increase to 15,638 constitutes growth of about 15 percent,” wrote Katherine Hempstead, Ph.D., senior policy adviser for the foundation.

Centene Corp. this month agreed to pay $21.1 million to resolve inaccuracies related to the reporting of pharmacy benefit services costs for New Hampshire’s Medicaid Managed Care Management Program. In a Jan. 6 press release unveiling the settlement agreement, Attorney General John Formella said the state Dept. of Health and Human Services and Dept. of Justice began investigating Centene’s provision of pharmacy benefit services after similar probes in other states were made public. The agreement follows similar settlements in Arkansas, Illinois, Kansas, Mississippi and Ohio over the last year for a total of $214 million in payouts. Centene did not admit any liability, wrongdoing or violation of federal or state law. “This no-fault agreement reflects our commitment to prompt and transparent resolution of this matter and relentless focus on delivering high-quality healthcare outcomes to our members in the Granite State,” Centene said in a statement published by The Daily Journal.

With the annual open enrollment period for Affordable Care Act marketplace plans about to close, HHS reports that more than 14.2 million people have signed up for plans since the OEP started on Nov. 1, 2021. That figure includes 10 million people selecting or being automatically enrolled in plans on HealthCare.gov through Jan. 12 and 4.2 million on the state-based marketplaces as of Jan. 8. The federal OEP for 2022 plans ends Jan. 15 — making it a month longer than signup periods during the Trump administration. HHS also released a report that detailed how the expansion of premium subsidies under the American Rescue Plan Act has led more customers to choose plans with lower deductibles.

CMS issued a final rule on Dec. 29 that rescinded the Most Favored Nation model. The mandatory model would have priced Medicare Part B drugs on the U.S. market based on their prices in certain countries. An interim final rule that was published in November 2020 had been blocked from being implemented on Jan. 1, 2021.

CMS published a proposed rule on Jan. 12 that would rein in direct and indirect remuneration (DIR) fees, which pharmacies have long complained about. The proposal would save consumers about $21.3 billion but cost the federal government $40.0 billion from 2023 through 2032.

Humana Inc. said it is decreasing its net membership growth estimate for its individual Medicare Advantage products, sending the insurer’s stock tumbling. In a Jan. 6 filing with the Securities and Exchange Commission, Humana said it now expects to add 150,000 to 200,000 members to its individual MA plans in 2022, down from a range of 325,000 to 375,000 members. The company said its revised estimate “is primarily attributable to higher than anticipated terminations during the AEP [annual election period], combined with the expectation of higher than originally projected terminations for the remainder of 2022.”

Centene Corp. completed its $2.2 billion acquisition of Magellan Health, Inc. The previously announced deal will allow Centene to expand its behavioral health platform, increase its specialty health and pharmacy capabilities, and enhance its ability to address members’ whole health. Magellan Health will operate independently under Centene’s Health Care Enterprises umbrella, with CEO Ken Fasola and other members of Magellan Health’s leadership team continuing to lead the organization, Centene said on Jan. 4.

On the heels of announcing that private health insurers will soon have to reimburse Americans for at-home COVID-19 tests, President Joe Biden said on Dec. 21 that the federal government will also distribute a half-billion free at-home tests. During the president’s remarks, which come as case counts are rising due to the omicron variant, he acknowledged that “we need to do better with at-home testing,” adding that the administration will set up “websites where you can get them delivered to your home.” Biden also said the federal government will set up emergency testing sites in areas that need additional testing capacity, starting with sites in New York City.

Regeneron Pharmaceuticals’ monoclonal antibody treatment for COVID-19 has “diminished potency” when used against the omicron variant, while AstraZeneca plc’s antibody product “retained neutralizing activity” against the new variant. The antibody treatments remain the standard of care for unvaccinated COVID-19 patients with severe disease. Regeneron emphasized that its treatment is effective against the delta variant. However, omicron has become the dominant variant in recent days: the Associated Press reported 73% of new infections last week were omicron.

New statistics showing a rise in telehealth usage among Medicare beneficiaries during the pandemic make a strong case for permanently expanding telehealth coverage for Medicare patients. A new report from the HHS Assistant Secretary for Planning and Evaluation (ASPE) found that the number of FFS beneficiary telehealth visits rose from approximately 840,000 in 2019 to nearly 52.7 million in 2020, with the largest increase seen in behavioral health specialist visits. Black and rural beneficiaries demonstrated lower use of telehealth compared with white and urban beneficiaries, respectively. The report did not include results for Medicare Advantage members, since plans had discretion to offer telehealth prior to the pandemic, noted ASPE. Meanwhile, a new Medicare Telemedicine Data Snapshot from CMS showed that the number of Medicare beneficiaries (including MA enrollees) using telemedicine services between March 1, 2020, and Feb. 28, 2021, increased over 30 times the number of users from the prior year (March 2019 to February 2020). Dual eligibles had higher use of telehealth than those with just Medicare. “These latest numbers prove that when given the resources and opportunity to use telemedicine, many of these patients will opt to use the technology,” wrote Connected Nation, which seeks to fill broadband and digital technology gaps through partnerships across all sectors. “We would argue that among the critical needs is to expand not only access to broadband but also working to ensure it is affordable and that others understand both how to access the technology and how it can benefit them.”