Medicare Advantage
- Centene announced that it would stop paying commissions for its Part D plans. The change is intended to shift more enrollees away from these plans and towards Centene’s Medicare Advantage plans.
- Sanford Health announced it was leaving Human’s Medicare Advantage network. Providers leaving MA networks has been a growing news item as providers have been points to pre-treatment approvals and payment timing as a reason for exiting market.
Johnson & Johnson & 340B
Johnson and Johnson announced this week that it would require hospitals in the federal 340B drug discount program to buy the drugs at full price starting in mid-October. Hospitals would then have to submit drug claims data to receive a rebate. HHS has signaled that J&Js proposed change does not comply with federal regulations so a potential fight between HHS and J&J could be in the cards.
New Gene Therapy Utilization Lower than Expected
Last year one of the big questions was around very expensive gene therapies and the associated cost. To date actual utilization has been lower than expected. For example, new treatments for sickle cell disease and hemophilia have only had about 27 patients so far this year. While the expectation is that usage would increase later in the year and into next year, to date actual utilization has lagged expectations.
CBO
CBO responded to a Congressional inquiry around expected premium tax credit spending related to the ACA. In 2020 CBO initially estimated that premium subsidies would cost around $600 billion between 2021 and 2030. This year, CBO estimates that spending would be $1.3 trillion between 2025 and 2034. The difference is higher than expected enrollment.
