Health insurance is in the news this week as insurers file their 2019 rate requests for Affordable Care Act Exchanges. The bad news: rates appear to be going up across many companies and states. The good news: The ACA appears to have helped more young women receive an earlier cancer diagnosis thanks to extended coverage under their parents’ insurance policies. Mergers are also in the news, with some questioning the CVS-Aetna and other mergers as creating too-big market leaders. Lastly, President Trump has appointed Acting VA Secretary Robert Wilkie to head the Veterans Affairs office. Read on for more in this week’s Innovation Partners BioBlog.
Health insurers are sending clear signals that policy changes will affect their calculations. As they begin filing 2019 rate requests for Affordable Care Act (ACA) exchanges, Cigna Corp. requested an average 15% increase in Virginia, CareFirst BlueCross BlueShield filed an average rate increase of 18.5% for its CareFirst BlueChoice HMO plans in Maryland and a 91.4% hike for its PPO plans there. In Virginia, the insurer is seeking an average 26.6% hike for its CareFirst BlueChoice plans and a 64.3% increase for plans offered by subsidiary Group Hospitalization and Medical Services, Inc. Nearly all insurers are acting swiftly to adjust rates in reaction to policy changes and updates.
Democrats were up in arms over the Trump administration’s failure to enforce a rule that would allow regulators to crack down on manufacturers that fail to offer discounts. The Office of Inspector General (OIG) has the authority to fine manufacturers that knowingly charge a 340B entity more than the ceiling price of a drug but repeated delays enacting the Obama-era rule are sabotaging efforts. Transparency and changes like this have plagued the 340B program.
It seems just common sense that companies who spend millions – sometimes billions – of dollars to patent new drugs do not want competitors issuing generic versions. Tactics to circumvent this include filing patent extensions, finding new uses for older drugs, and other actions. FDA Commissioner Dr. Scott Gottlieb calls this ‘gaming the system’ and vowed to work on this as part of the government’s program to tackle the high cost of drugs.
A survey released on May 16 finds that the majority of physicians are very concerned that recent proposals to reform the Medicare Part B program will have a negative impact on patient care. Many responding to the survey had negative interactions with patient impact of bureaucratic Pharmacy Benefit Manager (PBM) middlemen in the Part D program, and fear recently proposed changes to the Medicare Part B program will reduce care choices, drive up costs, increase administrative burdens, and decrease physician autonomy.
With several planned mergers in the works, some fear the reduction of competition in the marketplace. The proposed mergers of Cigna-Express Scripts and CVS Health-Aetna would further consolidate the Medicare Part D marketplace, research by the Kaiser Family Foundation found. The merged entities, plus Humana and UnitedHealth, would cover 71% of all Part D beneficiaries. Experts are comparing this to Verizon and AT&T market share of the wireless industry and how it has impacted service and costs.
A surprising benefit from the Affordable Care Act has been identified: earlier cancer detection in young women. Researchers say that the ACA’s expansion of insurance coverage from parents to children up to age 26 resulted in more young women receiving earlier cancer detection and treatment thanks to access to insurance. The study, published in Obstetrics & Gynecology, noted that the impact of the ACA now means that four out of five women ages 19 to 26 now have health insurance compared to 1 in 3 before the ACA came into effect.
Acting VA Secretary Robert Wilkie will assume the role as the next secretary of the Department of Veterans Affairs, according to a new statement by President Trump. Trump made the announcement on May 18 at a summit on prison reform. Wilkie has been acting head since David Shulkin resigned in March.