Health Plan Weekly

Despite Colorado’s robust insurance market, relative newcomer Friday Health Plans has managed to gain traction in its first few years. The company recently inked a $50 million funding agreement that may help it expand into new territories and provide the necessary tools to increase enrollment.

Launched by Sal Gentile, CEO, and David Pinkert, president, both health care industry veterans, Friday Health got its start as the two realized that the market was changing with individuals making more decisions, Gentile tells AIS Health. “The inspiration came from watching the development of the market, believing what ultimately would become a consumer-based market…and that plans, operations and tools were going to be necessary to be focused on the health care consumer.”

An earlier version of this article incorrectly stated that Jeff Myers is the former CEO of WellCare Health Plans, Inc. Myers was never WellCare’s CEO, but worked closely with WellCare’s leaders when Myers was CEO of Medicaid Health Plans of America (MHPA). WellCare is a member of MHPA. This version has been corrected.

On Jan. 21, Paula Tregre, Louisiana’s head of procurement, canceled the state’s newest Medicaid contract awards — but not for the reasons you might think. Meanwhile, Kentucky is working through its own bidding controversy after the state’s new governor called off Medicaid pacts awarded in December.

✦ Having now satisfied all necessary regulatory requirements, Centene Corp. and WellCare Health Plans, Inc. closed their $17 billion deal on Jan. 23. Centene is the country’s largest managed Medicaid insurer and the biggest player on the Affordable Care Act exchanges, and the acquisition of WellCare will increase its footprint in the Medicare Advantage market. Centene now serves more than 24 million members across all 50 states, according to a press release. With the completion of the transaction, the divestitures of Centene’s Illinois Medicaid and Medicare Advantage plans, WellCare’s Missouri Medicaid and Medicare Advantage plans and WellCare’s Nebraska Medicaid plan have also closed, the companies noted. Visit https://bit.ly/2uoxotk.

✦ Horizon Blue Cross Blue Shield of New Jersey and 17 other Blues plans unveiled a partnership with Civica Rx — the not-for-profit generic drugmaker founded by health systems and national charities — which will “create a new subsidiary dedicated to lowering the cost of selected generic drugs.” The Blues subsidiary will acquire and develop Abbreviated New Drug Applications for generic drugs that have a high price tag due to limited competition, and it will collaborate with Civica and manufacturing partners to bring more affordable generic drugs to market, with the first drugs expected by 2022. Visit https://prn.to/37ohhKC.

In a blow to the managed care industry, the Supreme Court chose to delay intervening in Texas v. United States, the Republican state attorneys general-led lawsuit that would overturn the Affordable Care Act (ACA).

“By declining to take up this case in an expedited manner, the Supreme Court leaves in place the cloud of uncertainty that hangs over the Affordable Care Act,” said Association for Community Affiliated Plans (ACAP) CEO Margaret A. Murray in a press release. “We are disappointed in the Court’s decision. Consumers will continue to pay the price for this confusion as the case stagnates, but we remain confident the ACA will withstand this challenge.”

As payers brace themselves for accelerated approvals of cell and gene therapies, they are searching for ways to manage those costs. In an effort to keep pace with competitors, CVS Health Corp. entered the fray, sketching out its strategy for delivering and covering gene therapy in the white paper “Gene Therapy, Keeping Costs From Negating Its Unprecedented Potential.”

There are 800 investigational new drug applications for cell and gene therapies, according to Sarah Butler Donovan, head of client solutions, marketing and operations at Avalere, and the FDA has had to hire 50 new reviewers that are going to be focusing on these new areas. “We’re anticipating, starting this year, roughly 10 approvals for cell and gene therapies a year,” Donovan said during a recent webinar.