In this week’s Innovation Partners BioBlog, we report on health insurers profit with UnitedHealth the most profitable followed by CVS. Oscar Health is taking the extraordinary step of offering 100 medications at $3 each to encourage patients to continue taking much-needed medicines for chronic health conditions. New research into breast cancer shows that cancer cells hide in healthy lung cells, causing the spread of secondary tumors. This and much more in this week’s BioBlog.
Roche’s solo Tecentriq advances toward Keytruda showdown with ‘priority’ boost in lung cancer
Roche’s regulatory boost from the FDA for Tecentriq has made its race with Merck’s Keytruda very interesting. Roche’s phase 3 Impower110 study, which showed Tecentriq could cut patients’ risk of lung cancer worsening or death by 41%. The checkpoint inhibitor extended patients’ lives by an additional 7.1 months compared with chemo, with those receiving the checkpoint inhibitor living a median 20.2 months versus chemo’s 13.1. Tecentriq posted a better hazard ratio than Keytruda did in either the Keynote-042 or the Keynote-024 study although the two studies are not apples-to-apples.
Health insurers’ profits topped $35B last year. Medicare Advantage is the common thread
Growth in Medicare Advantage seems to be fueling health insurers’ profits. Health insurers posted $8.2 billion in profit for the fourth quarter of 2019 and $35.7 billion over the course of the entire year. UnitedHealth Group was the most profitable company on the list, netting $3.5 billion in profit for the quarter and $13.8 billion in profit across 2019. By comparison, the second-place finisher, CVS, earned $1.7 billion in quarterly profit and $6.6 billion in profit for the year. CVS beat UnitedHealth in revenue, posting $66.9 billion in fourth-quarter revenue and $256.8 billion in annual revenue. UnitedHealth earned $60.9 billion in revenue for the quarter and $242.2 billion in revenue for the year.
The 3 biggest questions providers have as CMS’ direct contracting deadline nears
Potential applicants for the Trump administration’s new direct contracting value-based payment model are worried about missing key deadlines. Although February 25 is the application deadline to be part of the implementation year for direct contracting, key questions such as how will vendors be paid have yet to be answered. Other lingering questions include wondering when more information will be provided and if CMS can assist with the administrative burden.
Oscar Health offers $3 a month drug prescriptions
Oscar Health, an insurance company is offering its members $3 a month drug prescriptions for 100 different drugs. The list covers brand-name drugs and provides low prices for 90% of its members. Plus, it is pre-deductible, meaning members do not have to meet their deductible to take advantage of the price. The low prices do not apply to catastrophic plans, small group plans, or Medicare. Oscar believes this will help people with chronic conditions stick to their medication. In 2019, prices for more than 4,300 prescription drugs increased at an average of 21% year-over-year, according to Kaiser Health News. An estimated 29% of adults skip meds because of cost and one in four Americans taking prescription drugs said those drugs are difficult to afford.
Affordable Care Act exchanges grow as insurer participation rises
The Affordable Care Act brought about many changes, including the insurance exchanges. According to a new analysis by McKinsey and Company, participation continues to grow as insurer participation rises. In total, 245 individual insurance carriers took part in federal and state exchanges during the 2019-2020 plan year. In 2018-2019 that number was only 218; and in 2017-2018 it was lower still, at 194. Consumers now have more choices as the number of counties with just one insurance carrier dipped from 36% in 2019 to 25% in 2020. The program is still short of the 333 insurance providers it had in 2015.
Targeting hibernating breast cancer cells in the lung could reduce secondary cancers
A new report published in Nature Cell Biology found that cancer cells hibernate in healthy cells. This enables secondary tumors to form. After cancer cells from a breast tumour arrive in the lungs, a signal sent out from the lung cells causes cancer cells to change shape and grow protrusions that latch onto the lung tissue. The lung cells then protect them within the lung tissue. In the study, a treatment that interferes with the growth of these protrusions on the breast cancer cells reduced the number of secondary tumours in test mice compared to control subjects.
FiercePharmaPolitics—Grassley pushes for Senate drug pricing bill to pass by May
Republicans are pushing back at the Democratic bill to lower drug prices, with Senators Grassley and Wyden leading the charge. The Grassley-Wyden bill out of the Senate Finance Committee would limit price hikes in Medicare to the rate of inflation and implement an out-of-pocket cap for patients. If companies were to raise prices above the rate of inflation, they’d be forced to pay a rebate. Democratic Senator Nancy Pelosi’s bill, which has passed the House, a more aggressive bill calls for Medicare price negotiations, penalties for drugmakers that don’t negotiate, an international price index and more.