Spotlight on Market Access

The SCAN Group, a not-for-profit health care organization founded in 1977 as the Senior Care Action Network, is the parent company of SCAN Health Plan, one of the largest Medicare Advantage (MA) insurers in its home state of California. SCAN offers health insurance products for older adults and Medicare-Medicaid dual eligibles, including MA and Special Needs Plans (SNPs), serving markets in California, Arizona, Texas and Nevada. In recent years, SCAN has begun offering tailored MA plans that cater to the unique health care needs of diverse communities, including women, LGBTQ+ seniors and Asian Americans. The company nixed merger plans with fellow nonprofit insurer CareOregon in early 2024.

While the “Big Three” PBMs’ private-label subsidiaries have drawn recent attention for their agreements with pharma companies to offer their own branded biosimilars, one of these planned arrangements has landed a manufacturer in hot water.

Johnson & Johnson and its Janssen Biotech, Inc. subsidiary — now known as Johnson & Johnson Innovative Medicine — on Feb. 24 filed a lawsuit (Case 2:25-cv-01439) against Samsung Bioepis Co. Ltd. over its attempts to sell a private-label biosimilar of J&J’s interleukin-12/IL-23 antagonist Stelara (ustekinumab) via an unidentified PBM private-label subsidiary in addition to Samsung’s Pyzchiva (ustekinumab-ttwe) biosimilar.

Private equity firms continued to invest in health care at a steady pace in 2024, despite the increasing regulatory scrutiny and high interest rates, according to an annual report from the Private Equity Stakeholder Project.

The report tracked 1,049 unique PE-backed health care deals in 2024, a 7.6% decrease compared to 2023. The deals included 166 leveraged buyouts, 262 growth/expansion investments, and 621 add-on acquisitions to 383 unique platform companies. At least 16 PE firms completed 10 or more deals. And at least 13 PE-owned platform companies made five or more add-on acquisitions, over half of which were dental care companies.

Fourth-quarter 2024 “capped a dynamic year” for merger and acquisition (M&A) activity within health care services, including among large wholesalers purchasing physician groups, as well as interest in infusion providers. That’s according to health care investment banking firm Provident Healthcare Partners in introducing the most recent quarter’s market update report. In addition, private-equity groups continued to be active within health care services, both with platform companies and add-ons to those entities. And with a new administration perceived by many to be pro-business, expectations are high that deal activity across several sectors will be strong, say many industry experts.

In fact, this already has been seen in the pharma industry, which started the new year with multiple deals unveiled at the J.P. Morgan Healthcare Conference in mid-January, led by Johnson & Johnson’s $14.6 billion deal for Intra-Cellular Therapies.

The FDA recently approved a new antibody-drug conjugate (ADC) for the treatment of the most common form of breast cancer. While payers expect it to have some impact in their management of the condition, oncologists said they anticipate it having more of an impact on their prescribing, according to a Zitter Insights survey.

On Jan. 17, the FDA approved Daiichi Sankyo, Inc. and AstraZeneca’s Datroway (datopotamab deruxtecan-dlnk or Dato DXd) for the treatment of adults with unresectable or metastatic hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) breast cancer who have received endocrine-based therapy and chemotherapy for unresectable or metastatic disease. The agency used the Assessment Aid in its review of the Trop-2-directed antibody and topoisomerase inhibitor conjugate. The recommended dose is 6 mg/kg via intravenous infusion every three weeks, and the price of one 100 mg single-dose vial is $4,891.07.