News Briefs

AHIP appointed a new president and CEO: Mike Tuffin, UnitedHealth Group’s senior vice president for external affairs. Tuffin succeeds Julie Simon Miller, who has been the health insurance trade group’s interim CEO since September, when Matt Eyles stepped down. Eyles helmed AHIP for nearly five years and said in May that his move to resign was a “personal decision.” Tuffin is no stranger to AHIP, having served as the group’s executive vice president for public affairs from 2002 to 2012. Before his role at UnitedHealth, Tuffin was managing director of APCO Worldwide’s Washington, D.C. headquarters.

Rite Aid Corp. has delayed the auction of its PBM, Elixir Rx Solutions, as part of its Chapter 11 bankruptcy filing. According to a court filing, the auction was moved from Nov. 20 to Dec. 21 following a Nov. 21 hearing held by the District of New Jersey U.S. Bankruptcy Court. Rite Aid filed for bankruptcy on Oct. 15, at which time MedImpact Healthcare Systems presented a $575 million “stalking horse” offer for the company’s PBM — meaning an initial bid on a bankrupt company's assets from an interested buyer that aims to avoid low bids in a court auction. Under the newly revised schedule, competitive bids for Elixir must be received by Dec. 18 ahead of the Dec. 21 auction — which is the same date as the auction being held for Rite Aid’s retail stores.

On Dec. 8, the U.S. Department of Commerce’s National Institute of Standards and Technology and HHS unveiled draft guidance (88 Fed. Reg. 85593) on framework for exercising march-in rights on taxpayer-funded drugs and other products. The framework “specifies that price can be a factor in considering whether a drug is accessible to the public,” the administration said. That was one of other “new actions to promote competition in health care and support lowering prescription drug costs for American families.” Comments must be received by 5 p.m. Eastern on Feb. 6.

Since open enrollment began on Nov. 1, nearly 7.3 million people have signed up for Affordable Care Act health exchange plans for 2024, according to CMS. The data is through Dec. 2 for the 32 states that use the HealthCare.gov website and through Nov. 25 for the 18 states and Washington, D.C., that have state-based exchanges. More than 1.6 million of the people who enrolled, or about 23% of the total, did not have marketplace coverage in 2023. Enrollment runs through Jan. 15, 2024, for the states using HealthCare.gov, while the deadlines vary for state-based exchanges.

Optum, UnitedHealth Group’s health services arm, employs or has contracts with nearly 90,000 physicians and an additional 40,000 advanced practice clinicians, according to Optum Health CEO Amar A. Desai, M.D. Since there are about 950,000 active physicians in the country, that means Optum employs just under 10% of them. Desai, who spoke at UnitedHealth’s investor meeting on Nov. 29, added that Optum serves not only UnitedHealth’s members but also beneficiaries from more than 100 health plans. In addition, Optum serves more than 4 million people in fully accountable care arrangements and expects that number to increase to 5 million by late 2024.

Nearly 4.6 million have enrolled in Affordable Care Act exchange plans for 2024 since open enrollment began on Nov. 1, including 919,900 people who did not have exchange plans this year. The data captures sign-ups through Nov. 18 for people in the 32 states that use HealthCare.gov for enrollment and through Nov. 11 for people in the 17 states and Washington, D.C., that have state-based marketplaces. CMS Administrator Chiquita Brooks-LaSure said in a press release that “we have seen an increase in plan selections and a significant increase in the number of new enrollees year over year.” The open enrollment period runs through Jan. 15, 2024, for states using the HealthCare.gov website, while deadlines for state-based marketplaces vary.

The Biden administration on Nov. 16 released reports outlining steps it is taking to address social determinants of health and emphasizing the need to improve individuals’ social circumstances. The documents include the U.S. Playbook to Address Social Determinants of Health, the Call to Action to Address Health-Related Social Needs and a Medicaid and CHIP Health-Related Social Needs Framework. HHS Secretary Xavier Becerra said in a press release that “it is clear that the health of our people does not exist in a vacuum, but it is affected by our access to stable housing, healthy food and clean air to breathe.”

The CDC announced on Nov. 16 that it had made available more than 77,000 additional doses of Beyfortus (nirsevimab-alip), a monoclonal antibody intended to protect infants from severe respiratory syncytial virus (RSV) disease. Since the FDA approved Beyfortus in July, there have been supply issues and insurance coverage limitations for RSV medications. Sanofi, which manufactures Beyfortus alongside AstraZeneca, noted last month that it had seen “an unprecedented” level of demand for the medication and that it was working with the CDC to distribute more doses through the agency’s Vaccines for Children program.

CMS has delayed its plan to cover Medicare patients’ full cost of preexposure prophylaxis (PrEP) using FDA-approved antiretroviral drugs to prevent HIV infection in high-risk patients, according to KFF. CMS had announced the proposal in July and expected to make it official on Oct. 10, but KFF said the delay has occurred while CMS “is still working out details on how to transition coverage for patients already taking the drugs.” The drugs can cost more than $20,000 per year in the U.S.

The Cigna Group’s Express Scripts PBM announced on Nov. 14 that it’s launching a new “cost-plus” prescription drug pricing model for its clients. With the Express Scripts ClearNetwork, “clients pay a straight-forward estimated acquisition cost for individual medications, in addition to a small markup for pharmacy dispensing and service costs.” Express Scripts plans on launching the model in early 2024 and applying it toward generic, branded and specialty drugs. The move comes amid rising scrutiny from regulators over PBMs’ standard business practices like spread pricing, which allows PBMs to pocket the difference when pharmacies charge less for filling prescriptions than payers reimburse.

Five health care organizations, including AHIP and the American Medical Association, have launched the Common Health Coalition: Together for Public Health, according to a Nov. 9 press release. The coalition is “focused on translating the hard-won lessons and successes of the COVID-19 pandemic response into actionable strategies that will strengthen the partnership between our health care and public health systems.” The other founding members are the Alliance of Community Health Plans, American Hospital Association and Kaiser Permanente. Dave A. Chokshi, M.D., a physician at Bellevue Hospital and former New York City Commissioner, is chair of the Common Health Coalition.

A KFF report released on Nov. 8 found that 3,959 Medicare Advantage plans are available for individual enrollment next year, the second-largest number of plans since 2010 and a 1% decrease from this year. Meanwhile, the average beneficiary will be able to choose from 43 plans, the same as this year's record high. Eighty-nine percent of MA plans will offer prescription drug coverage in 2024; while 83% will offer telehealth benefits; and at least 97% will offer some dental, vision, fitness or hearing benefits.

A group of 32 Reps. led by Jerrold Nadler (D-NY) and Judy Chu (D-CA) sent a letter on Nov. 3 to CMS Administrator Chiquita Brooks-LaSure requesting increased oversight of artificial intelligence tools (AI) used to guide coverage decisions for Medicare Advantage plans. The elected officials wrote that “in recent years, problems posed by prior authorization have been exacerbated by MA plans’ increasing use of AI or algorithmic software managed by firms such as NaviHealth, myNexus, and CareCentrix to assist in their coverage determinations in certain care settings.” They asked CMS to require MA plans to report prior authorization data, compare guidance generated by AI tools with actual coverage decisions and assess whether plans are inappropriately using AI tools.

The state of California is facing delays in its efforts to produce low-cost insulin and is unlikely to meet its 2024 timeline, Bloomberg Law reports. Gov. Gavin Newsom (D) announced in March that the state had formed a partnership with Civica Rx to produce an insulin known as CalRx that would cost no more than $30 per 10ml vial and no more than $55 for a box of five, 3 mL pre-filled pens. However, California Health and Human Services Secretary Mark Ghaly, M.D., told Bloomberg Law the launch date would extend beyond 2024 due to unanticipated delays.

A group of 48 senators sent a letter to HHS Secretary Xavier Becerra, Dept. of Treasury Secretary Janet Yellen and Dept. of Labor Acting Secretary Julie A. Su asking for the Biden administration to require all insurers to fully cover over-the-counter (OTC) contraceptives. The politicians want the plans to cover the medications with no copays or out-of-pocket costs and without requiring a prescription. Opill, the first FDA-approved OTC birth control pill, is expected to become available early next year. The senators signing the bill included Patty Murray (D-Wash.), chair of the Senate Appropriations Committee; Bernie Sanders (I-Vt.), chair of the Senate Health, Education, Labor and Pensions Committee; and Ron Wyden (D-Ore.), chair of the Senate Finance Committee.

As of Nov. 1, nearly 10.1 million people had been disenrolled from Medicare during the resumed eligibility redetermination process, according to KFF’s Medicaid Enrollment and Unwinding Tracker. KFF, which compiles data from CMS and state websites, noted that 35% of people with a completed renewal application were disenrolled from Medicaid, while the remaining 65% had their coverage renewed. The disenrollment rates range from 10% in Illinois to 65% in Texas. During most of the COVID-19 public health emergency, states have been banned from conducting routine eligibility checks on Medicaid beneficiaries, but that process restarted on April 1.

Medica, which offers health insurance coverage in 12 states, has promoted Lisa Erickson to president and CEO, replacing John Naylor, who announced his resignation in July. Erickson joined Medica as chief financial officer in April after spending three and a half years as senior vice president of industry and network relations at Optum, UnitedHealth Group’s health services subsidiary. Medica is based in Minnetonka, Minnesota, a Minneapolis suburb.