Radar on Medicare Advantage
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For Now, New Alzheimer’s Treatment Is Subject to Limited Medicare Coverage
Marking the second approval of an Alzheimer’s disease treatment aimed at slowing cognitive decline by reducing amyloid plaque buildup on the brain, the FDA on Jan. 6 granted accelerated approval to Biogen and Eisai, Co., Ltd.’s Leqembi (lecanemab-irmb). For now, the drug remains subject to the restrictive National Coverage Determination that Medicare gave its predecessor, Aduhelm (aducanumab-avwa), and similar Alzheimer’s treatments last year, but CMS could consider broader coverage if the drug receives traditional FDA approval.
The drug is indicated for the treatment of Alzheimer’s disease in people with mild cognitive impairment or mild dementia. Patients must have confirmed presence of amyloid beta pathology before starting treatment. The FDA gave the humanized immunoglobulin gamma 1 monoclonal antibody fast track, priority review and breakthrough therapy designations. Japanese pharmaceutical company Eisai developed the drug and will co-market it with its U.S. partner Biogen, which launched the controversial Aduhelm in 2021 and had to halve its price from $56,000 a year to $28,000. Eisai estimates the cost of Leqembi will be $26,500 per year, though the actual price could vary by patient.
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Seniors Make the Switch to Medicare Advantage in Increasing Numbers
The number of seniors who switched from traditional Medicare to Medicare Advantage increased annually from 2016 to 2020, according to new research published in JAMA Health Forum. The switch rate from traditional Medicare to MA grew to 6.8% in 2020 — more than three times higher than the switch rate from MA to traditional Medicare. This trend was noticed across populations with a variety of traits, including age, race and mortality status, and was particularly strong among Medicare-Medicaid dual eligibles. Switch rates from MA to traditional Medicare, meanwhile, are largely on the decline, but still more common among duals than non-duals. The study’s authors suggested this movement was a contributor to overall MA growth, noting that MA’s share of Medicare enrollment is projected to exceed 50% this year. They also observed that switching accounted for a growing share of new MA enrollment growth, rising from 49% in 2016 to 67% in 2020.
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News Briefs: UnitedHealth Group Reported Full-Year Revenue Growth of 13%, Maintained ’23 Guidance
Reporting financial results for the quarter and year ending Dec. 31, 2022, UnitedHealth Group on Jan. 13 said full-year revenues grew 13% year over year to $324.2 billion, and earnings from operations rose 19% to $28.4 billion. The company ended the year with an 82.0% medical loss ratio, which was consistent with projections provided at its annual Investor Day. The UnitedHealthcare segment reported full-year revenues of $249.7 billion, up 12% from the prior year, and operating earnings of $14.4 billion, up 20% from 2021. Those results were largely driven by growth in the number of people served, including an additional 615,000 in Medicare Advantage; overall MA enrollment exceeded 7.1 million at the end of 2022. UnitedHealth also reported adjusted earnings per share of $22.19 for full-year 2022 and maintained guidance of adjusted EPS between $24.40 and $24.90 for 2023.
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Sweeping MA, Part D Proposed Rule Touches on Everything From Stars to SNPs
Exceeding 950 pages in its initial prepublication version, CMS’s most recent rule proposing policy and technical changes for contract year 2024 is the Biden administration’s most complicated and sweeping Medicare Advantage and Part D rule to date. Following a comprehensive request for information issued last summer on various aspects of the MA program, the rule addressed many of the same hot-button topics — from health equity and misleading marketing to behavioral health and prior authorization — that CMS asked about in the RFI. Additionally, the rule proposed major reforms to the Star Ratings and contained meaningful clarifications for MA Special Needs Plans (SNPs).
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2023 Outlook: MAOs Mull How to Compete While They Brace for Change, Uncertainty
In a sweeping proposed rule for the 2024 contract year, CMS last month took a strong stance on multiple aspects of the Medicare Advantage program, from misleading marketing and prior authorization to quality gains incentivized by the Star Ratings. As plans digest the many changes proposed in that rule, several major unknowns remain that could impact their revenue streams and ability to compete going forward. For our annual series of outlook stories on the year ahead, we asked a range of industry experts to weigh in on how doing business in 2023 might differ from previous years. Here’s the first installment on industry challenges and trends as told to AIS Health, a division of MMIT.
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