April 25, 2024

Cigna Arm To Offer Humira Biosimilar At $0 Cost-Share

Finally, we are making some advances on biosimilar adoption.  For awhile, pharmacy benefits managers (PBMs) were teaming up with brand drug makers to stop the uptake of biosimilars through rebate arrangements.  That still happens, but PBMs are seeing the light. Evernorth’s Accredo Specialty Pharmacy will make a Humira biosimilar available to patients with no cost-share. Evernorth is partnering to produce the biosimilar. The biosimilar price is about 85% lower than that of the brand.

#biosimilars #drugpricing #brandrugmakers #cigna #evernorth


Kaiser Permanente Reports Major Breach

A data breach at Kaiser Foundation Health Plan affected more than 13 million individuals.  It is not a hack or ransomware attack.  It appears the plan’s technology may have inadvertently transmitted personal information to Google, Microsoft Bing and X.

(Article may require a subscription.)

#cyberattacks #kaiserpermanente #breaches


Mixed News For Molina Healthcare

The Molina stock went down on mixed news.  Its medical loss ratio increased in Q1 over a year ago. It continues to lose Medicaid lives, but says it will be boosted over time with Medicare Advantage (MA) lives as new federal rules require members to enroll in health plans that integrate Medicare and Medicaid. It also lost Medicaid contracts. For the first time it announced its acquisition of Bright Health’s MA members.

(Article may require a subscription.)

#molina #medicareadvantage #medicaid #managedcare


Major No Surprises Mandate Still Being Studied

The major new health plan mandate that requires an Advanced Explanation of Benefits (AEOB) is still being worked on well after it was required.  The Centers for Medicare and Medicaid Services want to pilot the program, which require providers to send a Good Faith Estimate (GFE) and the plan to produce the AEOB for patients.  CMS thinks the DaVinci FHIR API integration standard can be used.

(Article may require a subscription.)

#nosurprisesact #surprisebilling


GOP Fighting Back On Healthcare By Attacking Biden On MA Rates

The GOP is fighting back on Biden’s healthcare message by criticizing the cut to Medicare Advantage (MA) rates for 2025. While this is political season, the attack is a bit disingenuous as lawmakers on a bipartisan basis and the Centers for Medicare and Medicaid Services (CMS) each have adopted decidedly anti-MA messaging of late.

#medicareadvantage #2025rates


Sanders Wants Weight-Loss Price Reductions

My favorite lawmaker Sen. Bernie Sanders, I-VT, — did I really say this! – is launching an investigation into weight-loss drug prices in an effort to gain price concessions. Sanders rightfully is asking why Ozempic and Wegovy are so costly in the United States.  Ozempic $969 here and just $155 in Canada and $59 in Germany. Wegovy costs $1,349 a month here and $140 in Germany and $92 in the United Kingdom. Ozempic is cleared for use for diabetics, while Wegovy is cleared for general weight loss and with those who have cardiovascular disease.  Other GLP-1s have similar prices in the U.S. Kudos to Bernie!

#weightlossdrugs #drugpricing #brandrugmakers


— Marc S. Ryan

Leave a Reply

Your email address will not be published. Required fields are marked *

Available Now