Health Plan Weekly

In a proposed rule released on Nov. 25, CMS floated some ambitious changes to the regulations governing the Affordable Care Act (ACA) exchanges, most notably allowing states to ditch a centralized health plan marketplace and instead rely on private web brokers, agents and insurers to enroll people in coverage.

However, as with the recent revival of a rule that restructures the prescription drug rebate system in Medicare Part D (HPW 11/25/20, p. 5), legal experts say this regulation may never be implemented as written.

Although a judge has already ruled in a lengthy court battle over the breakup fee and damages related to Anthem, Inc.’s failed attempt to acquire Cigna Corp., litigation related to the doomed deal apparently is not yet over. Instead, a lawsuit recently filed by Cigna shareholders seeks to hold that company’s leaders responsible for their alleged “sabotage” of the acquisition.

Anthem and Cigna first unveiled their $54 billion transaction in 2015, on the heels of Aetna Inc. and Humana Inc. announcing their own blockbuster combination. The Dept. of Justice sued to block both deals on antitrust grounds in 2016, and federal judges sided with regulators in both cases in February 2017.

✦ Americans’ satisfaction with their health insurance has dipped to its lowest point since 2016, according to American Customer Satisfaction Index (ASCI) Finance, Insurance, and Health Care Report for 2019-2020. The sector’s score weakened 7.2% year over year for an ASCI score of 72 out of 100, and Humana Inc. remained in the lead with a 75 — though its score declined 5%. The Blue Cross and Blue Shield Association scored an industry-average 72 but bucked the declining-satisfaction-score trend by seeing a 1% uptick. And “at the bottom of the industry, CVS Health’s Aetna plummets 7% to 71,” according to a press release summing up the report. Read more at https://bit.ly/3pZN7qL.

✦ In 2021, 30 health insurers are entering the Affordable Care Act exchanges across 20 states, and another 61 insurers are expanding within states where they already operated, according to a new analysis from the Kaiser Family Foundation. Next year there will be an average of 5.0 insurers per state in the exchanges, which is still below the high of 6.0 insurers in 2015 but far improved from the low of 3.5 in 2018. In 2021, 78% of enrollees will have a choice of three or more insurers, up from 67% of enrollees in 2020 and 58% of enrollees in 2019. Meanwhile, only 10% of counties have only a single insurer offering in 2021, down from 52% of counties in 2018. Visit https://bit.ly/3nUCYda to learn more.

On Nov. 20, as part of a health care regulatory blitz taking place in the waning days of the Trump administration, HHS finalized a once-tabled regulation that would revamp the Medicare prescription drug rebate system. This time around, HHS is promising that the so-called rebate rule won’t raise costs for Medicare beneficiaries or the federal government, but some experts remain skeptical.

The rebate rule first appeared in January 2019 in a notice of proposed rulemaking (NPRM), which aimed to remove safe-harbor protections under the federal anti-kickback statute for rebates that drug manufacturers provide to Medicare Part D plans, PBMs and Medicaid managed care organizations. But the administration pulled the proposed rule in July 2019 amid estimates from the Congressional Budget Office (CBO) and CMS’s Office of the Actuary that it would increase federal spending and Medicare beneficiary premiums.