This is Jacob Emerson with the Becker's Payer
Issues podcast. Here is your biweekly industry news
briefing for August 28th.
Centene will no longer pay commission to insurance
brokers enrolling or renewing members in its Medicare
Part d plans.
In a message sent to brokers on August
25th,
Centene said it will continue paying compensation to
brokers enrolling members in its WellCare Medicare Advantage
Plans. In its message, Centene said the inflation
reduction act has resulted in significant changes
to Part d.
Company wrote that to continue providing access to
high quality health care and Part d coverage
that helps families and individuals, we have made
the difficult decision that effective January 1, 2025
to cease new and renewal commissions for prescription
drug plans beginning with the 2025 plan year.
In 2024, provisions of the IRA that eliminated
co pays for party beneficiaries
who enter the catastrophic phase of coverage took
effect. In 2025, a $2,000 out of pocket
spending cap will apply to part d members.
Medicare Advantage and Part d plans pay brokers
compensation for new enrollments and renewals in their
plans.
The National Association of Benefits and Insurance Professionals
said in an August 27th statement that the
decision to cut commissions threatened not only the
livelihoods of Medicare agents, but also the communities
they serve and the seniors who rely on
their expert guidance.
Centene was the 4th largest Part d plan
sponsored in 2023.
The company had 6,600,000
Part d members as of June.
Well, Cigna is removing Humira from its largest
commercial formularies in 2025.
Express Scripts will have several biosimilar alternatives to
the biologic drug available through its formulary.
A new Humira biosimilar is available for $0
for patients of Cigna's Accredo specialty pharmacy.
Express Scripts is the 2nd major PBM to
replace Humira with its biosimilar competitors
following CVS Caremark replacing Humira with biosimilars from
its main formularies on April 1.
Well, CMS dropped a proposed regulation that would
have required Medicare Advantage Plans to return overpayments
found during chart reviews,
amid industry opposition.
That's according to a KFF report on August
27th.
In 2014, CMS proposed a rule that would
have required health plans reviewing patients' medical records
to identify potential overpayments and return them to
the agency.
CMS dropped the proposed rule later that year
after pushback from payers.
Records released from a 2022 deposition
show that CMS officials decided to abandon the
rule after concern from insurers, and the rule
change was at the center of a civil
fraud case against UnitedHealth Group that has been
pending for more than a decade.
In those records recently made public, CMS officials
said they decided not to move ahead with
the regulations because of, quote,
stakeholder concern and pushback.
The case was filed in 2,011 by a
former UnitedHealth employee and was taken over by
the justice department in 20
17. The DOJ is alleging that it paid
UnitedHealth $2,100,000,000
between 2,009 and 2016
for unsupported billing codes, which it says United
should have removed.
But because the proposed rule was not finalized,
UnitedHealth said in court rulings it should not
be penalized for failing to follow a regulation
that CMS did not adopt.
Well, Aetna will cover intrauterine
insemination
as a medical benefit for eligible plans,
a move the insurer called a, quote, landmark
policy change.
Intrauterine
insemination or IUI is usually only covered if
employers offer a separate fertility benefit plan.
This new change from Aetna will apply to
fully insured commercial plans.
Back in May, Aetna settled a lawsuit alleging
its fertility coverage policies discriminated against LGBTQ
plus couples.
As part of that settlement, Aetna said it
would introduce a new health plan that includes
artificial insemination as a standard benefit for all
members
regardless of sexual orientation.
The company said it will also take steps
to ensure its covered its coverage policies for
in vitro fertilization
are not more burdensome for LGBT
couples than heterosexual couples.
Fertility treatments are often not covered by insurance.
In 2017,
23% of employers with more than 500 employees
covered IUI, and 35%
of employers with more than 2,000 20,000 employees
covered the treatment.
And finally, Elavance Health is reportedly no longer
among the potential purchasers
of Evolent Health. That's according to exclusive reporting
from Reuters.
On August 22nd, Reuters had reported that Elavance
was considering purchasing the health care software
company, and sources familiar with the deal told
Reuters on August 26th
that the company had dropped out of that
process.
Evolent Health, launched by UPMC Health Plan, creates
software to help providers transition from fee for
service to value based arrangements.
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