Current Market Access to Migraine Medications

The FDA in September approved two new migraine drugs: Eli Lilly and Co.'s Emgality and Teva Pharmaceuticals' Ajovy, which will compete with Aimovig from Amgen Inc. and Novartis AG. For most migraine medications on the market, more than half of covered lives are under the preferred tier/preferred with prior authorization or step therapy and covered tier/covered with PA/ST, as of November 2018. The chart below shows how migraine medications are covered among commercial health plans, health exchange plans and Medicare and Medicaid programs under the pharmacy benefit.

NOTE: The number of total covered lives is 302.1 million. For Migranal, about 0.1% of covered lives are under the generic (preferred) tier.

SOURCE: Managed Markets Insight & Technology, LLC database as of November 2018. 

U.S. judge raises prospect of not approving CVS-Aetna deal

NOVEMBER 29, 2018 / 8:33 PM

WASHINGTON (Reuters) - In an unusual move on Thursday, a federal judge raised the prospect of not approving CVS Health Corp’s deal to buy insurer Aetna Inc, which closed earlier this week, during a routine portion of the legal process.

Judge Richard Leon of the U.S. District Court for the District of Columbia objected to what he said was the government’s and companies’ treatment of him as a “rubber stamp” for the deal, noting that CVS had closed its deal to buy Aetna for $69 billion on Wednesday.

CVS said in a statement, “It’s commonplace for acquisitions to close before this final step in the process is complete, and our focus remains on delivering on the combined company’s potential.”

The Justice Department did not immediately return a request for comment. 

The Justice Department gave its OK in October for the merger of CVS, a pharmacy and benefits manager firm, and Aetna on condition that the health insurer sell its Medicare Part D drug plan business to WellCare Health Plans. The court must approve the agreement between the government and merging companies.

Leon raised the prospect of not deciding on the deal until the summer, or perhaps rejecting it, before setting another hearing for Monday.

“I was reviewing your motion, which, of course is not opposed. And I kind of got this uneasy feeling that I was being kept in the dark, kind of like a mushroom,” Leon told lawyers for the Justice Department and the two companies, noting that the American Medical Association, among others, had objected to the deal.

“I’m very concerned, very concerned that you all are proceeding on a rubber-stamp approach to this,” he told them, according to a transcript of the hearing.

(This story corrects attribution in paragraph 3 to reflect merged companies)

Reporting by Diane Bartz; Editing by Lisa Shumaker

Our Standards:The Thomson Reuters Trust Principles.

https://www.reuters.com/article/us-aetna-m-a-cvs-health/u-s-judge-raises-prospect-of-not-approving-cvs-aetna-deal-idUSKCN1NZ07S?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202018-11-30%20Healthcare%20Dive%20%5Bissue:18343%5D&utm_term=Healthcare%20Dive

CMS offers states more waiver options to skirt ACA requirements

Les Masterson

Nov. 29, 2018

Dive Brief:

• CMS launched four waiver concepts for states on Thursday in what it called a bid to promote more affordability and flexibility in health insurance options.
• The new areas for State Relief and Empowerment Waivers, also called section 1332 waivers or state innovation waivers, are account-based subsidies, state-specific premium assistance, adjusted plan options and risk stabilization strategies.
• CMS said the options look to "spur innovation, reduce burdens for states with potentially limited policy resources or legislative schedules and illustrate how states might take advantage of new flexibilities." However, critics charge the move may hurt low-income people and promote short-term health plans that offer limited protections.​

Dive Insight:

In D.C. on Thursday, CMS Administrator Seema Verma unveiled the new ways states will be able to skirt elements of the Affordable Care Act to strengthen insurance markets. But the move was met with sharp criticism and allegations that the plan will flood the markets with "junk plans."

"Today, we are saying the states have the power to make the individual markets work through innovative policies that best meet the needs of your citizens. We are returning freedom, authority and innovation to you, state lawmakers. And I believe the results will be better and more Americans will be insured because of it," Verma said at the States and Nation Policy Summit of the American Legislative Exchange Council.

CMS said the plan is to give states more flexibility to test their own programs. Overall, a state would have greater power in determining how subsidies are allocated.

One example is to let states move subsidies into an account that people can use to pay for health insurance premiums or out-of-pocket expenses. This is a similar concept to health savings accounts, health reimbursement arrangements and flexible spending accounts found in employer-sponsored health insurance.

States would also be able to develop their own premium subsidy structure and decide who is awarded those subsidies. States could also decide what type of health insurance is eligible for subsidies, opening the door to subsidizing short-term plans, which aren't required to cover pre-existing conditions. 

These waivers free states from being forced into a "one-size-fits-all approach," CMS said in a statement.

Risk stabilization strategies will allow states to pay for high healthcare costs through reinsurance programs and high-risk pools. Reinsurance programs create pools for payers that can help stabilize the marketplace, help pay to insure high-risk people and result in lower premiums. Maryland's reinsurance program will lead to a 13.2% average decrease in individual market premiums in 2019.

HHS Secretary Alex Azar praised the new waivers in a statement: "The specific examples laid out today show how state governments can work with HHS to create more choices and greater flexibility in their health insurance markets, helping to bring down costs and expand access to care."

However, not everyone is pleased with the proposal. Larry Levitt, senior vice president at Kaiser Family Foundation, warned on Twitter that the rules could let states increase subsidies for wealthier people while reducing subsidies for poorer people. It could also allow states to spend premium subsidies on short-term plans that offer fewer consumer protections than an ACA plan.

Larry Levitt@larry_levitt

Nov 29, 2018

The Trump administration has filled in details of ACA waiver guidance, illustrating how states could restructure premium subsidies, including subsidizing lower premium plans that don’t cover pre-existing conditions. https://www.cms.gov/newsroom/press-releases/cms-administrator-discusses-initiatives-strengthen-health-insurance-markets …

Senate Finance Committee Ranking Member Ron Wyden, D-Ore., bashed the plan in a statement. Wyden said Section 1332 was meant to bring new ideas that improve health, but instead, the new waiver areas will increase consumer costs and lower quality of care.

"The Trump administration has created a fast lane to flood healthcare markets with junk plans and quarantine older Americans and those with pre-existing conditions apart from everyone else," Wyden said. "Trump's sabotage crusade continues to deprive working Americans with the healthcare security they need, and today's news accelerates America's slide back to the days when healthcare was reserved for the healthy and wealthy."

There's also a question to the legality of the proposal. The Brookings Institution in an article this week said the CMS avoided the rule-making processes in issuing guidance on the waivers. Sidestepping that process could make the proposal invalid, according to the think tank.

https://www.healthcaredive.com/news/cms-offers-states-more-waiver-options-to-skirt-aca-requirements/543272/

Bringing primary care to smartphones

BY RACHEL Z. ARNDT  | NOVEMBER 24, 2018

Ever since house calls fell out of favor, most medical care has been delivered in hospitals and doctor's offices. But apply smartphones and AI to the situation, and that need not be the case, at least not for primary care. The company 98point6, for one, wants to take primary care virtual, through text conversations.

The whole process will be more efficient, according to the company, not only because of streamlined communication but because of an assist from a combination of AI and human interaction.

“We've set out to dramatically 
augment the primary-care physician with deep technology by delivering an on-demand primary-care experience,” said Robbie Cape, CEO and co-founder of Seattle-based 98point6.

For patients, the experience begins with 98point6's automated assistant, which asks what's wrong. Behind the scenes, natural language processing and machine learning analyze the chat to narrow in on the relevant topic, allowing the assistant to ask questions that will give human physicians the information they need to diagnose and treat the problem.

“People want to be able to do things very efficiently,” said Waqqas Mahmood, director of advanced technology and innovation for advisory firm Baker Tilly. “If I can have the same experience as I would when talking to a human, that would be ideal, which is why there are all these new AI and cognitive technologies out there.”

The software itself isn't handling treatment—a physician is. After the initial narrowing, the software presents the case to 98point6's board-certified physicians, all of whom are permanent employees of the company. In anywhere from a few seconds to a couple of minutes, the physician connects with the patient, messaging to ask any additional questions—using video and photos, if necessary—and then will submit an electronic prescription, order labs, or recommend the patient see someone in person. But that last option is rare: More than 95% of cases are resolved virtually.

“Efficiency is a big gain out of this,” Mahmood said. From a cost perspective, provider organizations benefit, he said, because there's less human time on the phone.

Patients, meanwhile, benefit from greater access to care. “We're trying to give patients a level of access to medical expertise and care directly in their pockets so they're not going to Google to answer those questions,” Cape said.

After each encounter, a patient gets a care plan in the 98point6 app, and the information goes into 98point6's electronic health record. Patients can request that their visits be shared with outside providers.

In AI use cases like 98point6's, medical history is useful context, said Aaron Martin, chief digital officer at Providence St. Joseph Health. “The broader the context, the harder it is for it to be accurate,” he said. “It's going to be like walking into a clinic with no medical history, so the clinician is going to need to ask you a ton of questions.”

98point6 is currently focused on the self-insured employer market. Employers pay a single fee for unlimited access for their employees. “That's key,” Cape said, since a single fee doesn't limit patients' use of the service.

98point6 also has a direct-to-consumer offering, which costs $20 for the first year and $120 per year after that.

As the company grows, it will also come up with new ways to engage patients.

“We're going to figure out ways to proactively reach out to patients so we can practice old-fashioned primary care,” Cape said. “We want to be there for patients in sickness and in wellness.”

https://www.modernhealthcare.com/article/20181124/TRANSFORMATION01/181119931?utm_source=modernhealthcare&utm_medium=email&utm_content=20181124-TRANSFORMATION01-181119931&utm_campaign=dose

Poor communities wait longer for ambulances, causing health disparities

By Steven Ross Johnson  | November 30, 2018

Patients that experience heart attack in low-income neighborhoods tend to wait longer for emergency medical services to arrive than those living in more affluent communities, a discrepancy that could drive health disparities between the groups.

Ambulances took an average of four minutes longer to handle calls from low-income areas than high-incomes neighborhoods, according to an analysis published Friday in JAMA Network Open that looked at more than 63,000 cases of cardiac arrest. The study marks the first national study evaluating disparities in 911 responses for cardiac arrest in high-income and low-income neighborhoods.

Researchers measured the time it took ambulances to arrive at a patient's location after it was dispatched, how long it took an ambulance on the scene to depart, how long it took to transport a patient from the scene to the hospital, and the total emergency medical services time.

The study found communities where the annual median income was between $57,000 and $113,000 had an average overall emergency response time of 37.5 minutes compared to 43 minutes in ZIP codes where the median income ranged from $20,250 to $42,642. Researchers also found EMS responses were more likely to meet nationally recognized benchmarks of arriving within eight minutes to a like-threatening event.

Study lead author Dr. Renee Hsia, professor of emergency medicine at the University of California San Francisco and an emergency physician at Zuckerberg San Francisco General Hospital and Trauma Center, said the findings help to show one of the many inequities that have contributed to the widening gap in health outcomes between poorer and wealthier Americans.

Research published in 2017 in Health Affairs found that 38% of people living in households with annual incomes of less than $22,500 reported to be in poor to fair health between 2011 and 2013 compared to just 12% of individuals making more than $47,000 a year.

"We've been talking about disparities for decades in the United States and a lot of time people think it because physicians might be biased, but this shows that there are systemic issues that we can do something about," Hsia said. "It's not just about training providers to be more culturally competent there are system-level biases that exists, and this is one of them."

Hsia said there were a number of potential factors that could contribute to the disparity in ambulance wait times.

She said it was possible that the spate of hospital, emergency department and privately-owned ambulance company closures in recent years could be a contributing factor for the longer wait times. Previous research has found EDs tend to have a higher closure rate in hospitals that regularly receive a high proportion of uninsured patients due to the low reimbursement they receive.

A 2014 Health Affairs study also authored by Hsia found the number of EDs in the U.S. decreased by 6% between 1996 and 2009. That study found one-quarter of hospital admissions between 1999 and 2010 occurred near an ED that had closed, which led to a 5% increase in the odds of mortality at those hospitals.

The study surmised closures could have led to longer EMS times because of the added strain it put on existing emergency departments that become more overcrowded, and lead to diverting ambulances more often to other facilities that increases transportation times.

But Hsia said another factor for the disparity in wait times could be related to the increase in recent years in the number of privately-owned ambulance companies that are contracted by local governments to provide services to their communities. More cities and towns have turned to for-profit ambulance providers to save money since those companies tend to bill commercial and public insurers or the patient directly for their services.

Hsia said it was possible that the shift in who's answering those emergency calls could be contributing to the disparity since companies would likely try to position their resources to better meet the needs of communities that are more likely to give the best returns.

Hsia said government EMS directors might benefit from looking more closely at whether the response times of ambulance providers they consider contracting with are distributed evenly across poorer and richer communities.

"I think that it's important policymakers realize that as there are these shifts going from publicly-funded entities that are providing these services to privately-funded entities that there may be different incentives that underlie their provision of these services," Hsia said.

Evidence has shown delays in ambulance response times can have a large impact on mortality rates. A 2001 study published in the medical journal BMJ concluded reducing ambulance response times to five minutes could almost double the survival rate for cardiac arrests.

Steven Ross Johnson has been a staff reporter for Modern Healthcare magazine since 2013 and covers issues involving public health and other healthcare news. Johnson has been a freelance reporter for the Chicago Tribune, Progress Illinois, the Chicago Reporter and the Times of Northwest Indiana and a government affairs reporter for the Courier-News in Elgin, Ill. He received a bachelor's degree in communications from Columbia College in Chicago and a master’s degree in journalism from the Medill School of Journalism at Northwestern University.

https://www.modernhealthcare.com/article/20181130/NEWS/181139991?utm_source=modernhealthcare&utm_medium=email&utm_content=20181130-NEWS-181139991&utm_campaign=dose

The canary in the open enrollment coal mine

By Merrill Goozner  | November 30, 2018

Sign-ups for individual health plans during this year's shortened open-enrollment season are running well below last year's pace. The number of uninsured children is rising. The share of Americans without health coverage will undoubtedly tick up next year for the first time in nearly a decade.

This dubious achievement arrives just as the U.S. economy is nearing full employment. This shouldn't be happening.

Employers that offer health insurance are raising wages and bolstering benefits to attract workers. People working at jobs without benefits or in the gig economy are seeing rising incomes, which should make individually purchased plans more affordable.

It clearly took a lot of work by the Trump administration and the current Congress to undermine the exchanges where individual policies are sold. The administration removed insurance price stabilizers, ended cost-sharing subsidies for patients and slashed the budgets for the navigators who help people sign up. It also expanded the availability of “short-term” skimpy plans, which offer reassurance as long as their purchasers don't get sick. 

The outgoing Congress did its part by essentially ending the individual mandate. Some experts predicted this would have little impact and dismissed the Congressional Budget Office warning that 4 million fewer people would sign up on the exchanges for 2019 because of the zeroed-out tax penalty.

It turns out the CBO may have overestimated, but directionally was spot-on. If the current sign-up rate holds through the end of open enrollment on Dec. 15, more than 2 million fewer people will choose plans on the exchanges for 2019, about a 17% decline from 2018.

This will almost entirely offset the increase in employer-based coverage that one would expect from an improving economy. The latest Census Bureau survey showed employers added 2.5 million covered lives in 2017, a year when employment gains were comparable to the past year.

Next year's uninsured problem will be exacerbated by continuing efforts in some states to add work requirements to their expanded Medicaid programs. Arkansas, which was first to implement the new requirements, saw 12,000 people dropped from its rolls in the past three months.

It could get much worse. In a letter sent last month to HHS Secretary Alex Azar, the Medicaid and CHIP Payment and Access Commission noted over 90% of Arkansas beneficiaries failed to meet cumbersome reporting rules—even if they were working.

CMS Administrator Seema Verma promised to review the results. But at the same time, she vowed to continue the administration's push for work requirements. “We remain steadfast in our belief that this policy is important for the program,” she said.

It's poor timing for ideological 
rigidity. If the economy slows next year, which many economists predict, the last thing you want to do is create higher hurdles for low-income people needing Medicaid.

It's not too late for healthcare providers and insurers to undo some of the damage. To bolster sign-ups on the exchanges in the last few weeks of open enrollment, they can run media ads and press local TV and radio stations to run public service announcements. They can give emergency grants or assign personnel to local navigator groups, which saw 90% of their government funding evaporate.

But the die for next year is mostly cast. Hospital and physician practice finance officers need to begin preparing now for the coming fiscal realities. They are already seeing their uncollectable bills rise due to growth of high-deductible plans. They should expect another upward lurch in uncompensated care next year.

As margins shrink, it is inevitable that activity in the healthcare hiring hall, which has been going great guns since the end of the last recession, will slow sharply. You'd think the Trump administration would understand that's not what it wants going into a two-year battle to win re-election.

Merrill Goozner served as Editor of Modern Healthcare from December 2012 to April 2017. As Editor Emeritus, he continues to write a weekly column, participate in Modern Healthcare education, events and awards programs and provide guidance on coverage related to healthcare transformation issues. Over the course of his four decades in journalism, he served as a foreign, national and chief economics correspondent for the Chicago Tribune and professor of journalism at New York University. He is the author of The $800 Million Pill: The Truth Behind the Cost of New Drugs (University of California Press, 2004), and has contributed articles to numerous publications. Goozner earned a master's degree in journalism from Columbia University and a bachelor's in history from the University of Cincinnati, where he received the Distinguished Alumni Award in 2008.

https://www.modernhealthcare.com/article/20181130/NEWS/181129921?utm_source=modernhealthcare&utm_medium=email&utm_content=20181130-NEWS-181129921&utm_campaign=dose

Vanderbilt to keep Medicare funding after CMS threatened revocation

By Susannah Luthi  | November 30, 2018

Nashville's Vanderbilt University Medical Center won't lose its Medicare funding in December as recently threatened by the CMS, after the agency accepted the hospital system's revised plan of correction.

The CMS confirmed it has accepted Vanderbilt's revised plan of correction, and that the hospital is not in jeopardy of losing its Medicare Provider Agreement or billing privileges.

In a statement, a Vanderbilt official said the hospital has been closely working with the Tennessee Department of Health and the CMS "to assure that any concerns they may have about patient safety are fully addressed."

"After submitting our plan of corrective action we were informed yesterday by both the [health department] and the CMS the plan has been accepted," said John Howser, Vanderbilt's chief communications officer. 

He added that the health department must return and "validate that our plan of correction has been appropriately implemented," but that the step will happen before Dec. 9.

Vanderbilt faced potential stripping of its Medicare contract on Dec. 9 after state surveyors looking into the 2017 death of a patient learned that a nurse had in error administered a high dose of an anesthetic instead of an anxiety medication. The mistake immediately killed the patient.

While the nurse was fired, the agency said the hospital was no longer qualified as a Medicare provider because it didn't report the incident to the state health department.

Susannah Luthi covers health policy and politics in Congress for Modern Healthcare. Most recently, Luthi covered health reform and the Affordable Care Act exchanges for Inside Health Policy. She returned to journalism from a stint abroad exporting vanilla in Polynesia. She has a bachelor’s degree in Classics and journalism from Hillsdale College in Michigan and a master’s in professional writing from the University of Southern California.

https://www.modernhealthcare.com/article/20181130/NEWS/181139993?utm_source=modernhealthcare&utm_medium=email&utm_content=20181130-NEWS-181139993&utm_campaign=dose

Medicare could overspend billions for lab tests

By Susannah Luthi  | November 30, 2018

Medicare may still spend more money than it should for clinical lab tests because the CMS hasn't gathered complete data on what private insurers pay for the same tests, even though the agency changed its laboratory fee schedule.

The Government Accountability Office found that if the agency doesn't tweak its phase-in of the pay cuts for these tests — where Medicare has been outspending commercial payers — the federal government could end up paying billions more than is necessary through 2020, according to a report released Friday.

For some tests, the CMS has already ended up temporarily paying higher rates than before as the agency started its reductions.

In 2014, Congress through the Protecting Access to Medicare Act required the CMS to overhaul the pay rates for laboratory tests for the first time in three decades. The CMS finalized its reductions last year and they went into effect Jan. 1 2018, spurring a lawsuit from labs as they faced hundreds of millions of dollars of lost revenue. The labs expect to see $4 billion in cuts over the next decade.

Ultimately, the federal judge presiding over the case said the court couldn't interfere because Congress "expressly precluded judicial review of issues such as these."

But the GAO wants HHS to take additional steps to safeguard Medicare funds under the new system, starting with the data on what private insurers are paying. The CMS has been relying on the labs facing the cuts to get an accurate financial picture of what the tests should cost.

"CMS relied on laboratories to determine whether they met data reporting requirements, but agency officials told GAO that CMS did not receive data from all laboratories required to report," the report said. "CMS did not estimate the amount of data it should have received from laboratories that were required to report but did not."

While the agency took precautions against inaccurate payment data, the GAO said it isn't clear that the CMS has enough information to make sure the Medicare rates will fully capture all the rate reductions authorized by Congress.

In addition, the CMS used Medicare's maximum pay rates from 2017 rather than the actual pay rates as the baseline to start the phase-in of the cuts, the watchdog said.

Subsequently, some labs actually saw an average pay boost rather than a reduction. For 2018 through 2020, Medicare may pay out $733 million more than it would if the CMS had used average pay rates from 2016 as the benchmark instead.

The agency also dropped its bundled payments for some panel tests — which are groups of laboratory tests typically conducted together — even though that's how Medicare had paid for them before the overhaul.

CMS officials said the agency hadn't clarified that it had the authority to maintain these bundled payments under the 2014 law,and GAO noted that the CMS is "currently reviewing" whether it can claim that authority.

HHS said in a response included in the report that officials are also looking at other ways they can reinstate bundles under current law, such as adding codes to the fee schedule.

If these payments remain unbundled, however, GAO estimates they could hike Medicare costs by as much as $10.3 billion this year through 2020.

HHS told GAO it will work on more complete data-gathering. But the department said any change to the way the CMS phases in the reductions would need to be done through additional rulemaking, and did not indicate whether it would take this step.

The size of the U.S. clinical laboratory market isn't known. The Healthcare Fraud Prevention Partnership estimated the industry garnered $87 billion in 2017, and a separate market report estimated revenues were $75 billion in 2016.

Estimates also vary over how the three most lucrative lab types split the money Between 37% and 54% of the total lab revenue has gone to independent labs in recent years, according to GAO. Between 21% and 35% goes to hospital-outreach labs, and 4% to 11% go to physician-office labs.

Susannah Luthi covers health policy and politics in Congress for Modern Healthcare. Most recently, Luthi covered health reform and the Affordable Care Act exchanges for Inside Health Policy. She returned to journalism from a stint abroad exporting vanilla in Polynesia. She has a bachelor’s degree in Classics and journalism from Hillsdale College in Michigan and a master’s in professional writing from the University of Southern California.

https://www.modernhealthcare.com/article/20181130/NEWS/181139997?utm_source=modernhealthcare&utm_medium=email&utm_content=20181130-NEWS-181139997&utm_campaign=dose

John Hancock Touts Early Returns On Apple Watch Monitoring Plan

PR Newswire  November 29, 2018 

New global research¹ released by Vitality, a leading behavior change platform, reveals that financial incentives combined with wearables encourage people to significantly increase their physical activity.

It's a finding consistent with the John Hancock Vitality Apple Watch user experience, and bolsters the company's recent decision to help all customers live longer, healthier lives by including Vitality on every life insurance policy it sells.

With the John Hancock Vitality program, customers have the option to earn rewards and potential premium savings through physical activity, better nutrition, mindfulness and preventative screenings.

The RAND Europe study of over 400,000 people in the U.S., U.K. and South Africa, the world's largest behavior tech study based on verified data, concluded that those who wore an Apple Watch and participated in the Vitality Active Rewards benefit program averaged a 34 percent sustained increase in physical activity compared to participants without an Apple Watch.

That's the equivalent of 4.8 extra days of activity per month.

In the U.S., the RAND study results revealed significant improvements in levels of physical activity:

·         The number of active days increased by almost 31 percent

·         Participants who had the highest level of inactivity and body mass index levels improved more than other groups, increasing physical activity by 200 percent in the U.S

·         High-intensity activity days increased by 52 percent

In addition, the study found that positive associations between Vitality with the Apple Watch benefit and physical activity persists over time.

John Hancock Joins Global Pledge with Aggressive Goal

John Hancock and parent company Manulife fundamentally believe insurers should help customers live healthier and have signed a global pledge with Vitality to help make 100 million people 20 percent more active by 2025.

"The RAND research proves the experience of our customers to date will have long-term impact – people can successfully take small, everyday steps to improve their overall health and a life insurance company can help them in that journey," said Marianne Harrison, CEO of John Hancock. "We're fully committed to this premise, and our pledge today will further reinforce our bold commitment to give people the tools they need to live longer, healthier lives."

Harrison, along with Manulife President and CEO Roy Gori and Manulife Canada President and CEO Mike Doughty, acted as signators in the pledge. Manulife recently announced it will give millions of group benefits employees access to the Manulife Vitality platform, starting this spring.

Apple Watch Series 4 Now Available for John Hancock Life Insurance Customers

John Hancock is also announcing today that policyholders can receive the new Apple Watch Series 4 for as little as $25 through regular exercise. The newest version of the watch can detect hard falls and features an electrical heart rate sensor that can also take an electrocardiogram.

"There is natural alignment between consumer health and longevity, and our goals as a life insurer. This type of shared value is good for everybody," added Brooks Tingle, president and CEO of John Hancock Insurance. "The Apple Watch has been an extremely popular and effective component of our program to date, helping our customers not only live healthier lives through better exercise and mindfulness habits – but also improve their financial wellness through the rewards our program offers, including lower premiums and discounts from some of their favorite national retailers."

In 2016, the company first introduced customers to the opportunity to earn an Apple Watch (for an initial $25 fee) to support their physical activity goals and earn points that reduce or eliminate their monthly payments for their watch over a two-year period. Last year, John Hancock expanded the offering to include the Apple Watch Series 3. Today's announcement furthers John Hancock's commitment to motivate customers to protect both their financial future and stay active and healthy.

For more information about John Hancock Vitality visit JohnHancockInsurance.com.

About John Hancock and Manulife 

John Hancock is a division of Manulife Financial Corporation, a leading international financial services group that helps people make their decisions easier and lives better. We operate primarily as John Hancock in the United States, and Manulife elsewhere. We provide financial advice, insurance and wealth and asset management solutions for individuals, groups and institutions. Assets under management and administration by Manulife and its subsidiaries were over CAD$1.1 trillion (US$863 billion) as of September 30, 2018. Manulife Financial Corporation trades as MFC on the TSX, NYSE, and PSE, and under 945 on the SEHK. Manulife can be found at manulife.com.

One of the largest life insurers in the United States, John Hancock supports approximately 10 million Americans with a broad range of financial products, including life insurance, annuities, investments, 401(k) plans, and college savings plans. Additional information about John Hancock may be found at johnhancock.com.

About Vitality

Guided by a core purpose of making people healthier, Vitality is the leader in improving health to unlock outcomes that matter. By blending smart tech, data, incentives, and behavioral science, we inspire healthy changes in individuals and organizations. Vitality brings a global perspective through successful partnerships with the smartest insurers and most forward-thinking employers around the world. More than 8 million people in 18 countries engage in the Vitality program. For more information, please visit www.vitalitygroup.com.

Insurance policies and/or associated riders and features may not be available in all states.

Apple Watch program is not available in New York. You can order Apple Watch Series 3 (GPS) or Series 4 (GPS) by electronically signing, at checkout, a Retail Installment Agreement with the Vitality Group, for the retail price of the watch. After an initial payment of $25 plus tax, over the next two years, monthly out of pocket payments are based on the number of workouts completed. Upgrade fees apply if you choose (GPS + Cellular) versions of Apple Watch Series 3 or Series 4, larger watch case sizes, certain bands and case materials. Apple is not a participant in or sponsor of this promotion. Apple Watch is a registered trademark of Apple Inc. All rights reserved.

Rewards and discounts are subject to change and are not guaranteed to remain the same for the life of the policy.

John Hancock Vitality Program rewards and discounts are only available to the person insured under the eligible life insurance policy.

Vitality is the provider of the John Hancock Vitality Program in connection with policies issued by John Hancock

Insurance products are issued by John Hancock Life Insurance Company (U.S.A.), Boston, MA 02210 (not licensed in New York) and John Hancock Life Insurance Company of New York, Valhalla, NY 10595.

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¹ RAND Europe 2018, Financial incentives and physical activity, Evidence from the Vitality's Apple Watch benefit, Marco Hafner, Jack Pollard and Chris van Stolk, page vii.

View original content to download multimedia:http://www.prnewswire.com/news-releases/john-hancock-and-vitality-prove-incentives-and-apple-watch-usage-boost-physical-activity-rates-by-more-than-30-percent-300756795.html

SOURCE John Hancock

https://insurancenewsnet.com/oarticle/john-hancock-touts-early-returns-on-apple-watch-monitoring-plan#.XAG8ZiX4-JA

More eHealth customers choosing short-term insurance plans

By Shelby Livingston  | November 29, 2018

Customers who buy plans on private health insurance exchange eHealth are taking advantage of their newfound ability to purchase an extended short-term insurance policy without triggering the individual mandate penalty, newly released data from the company shows.

Many more eHealth customers opted for short-term plans over unsubsidized Affordable Care Act-compliant plans during the first half of the ACA open enrollment period for 2019 coverage than during the previous open enrollment, eHealth said.

Among eHealth customers buying short-term plans and ACA plans without subsidies, seven in 10 enrolled in a short-term insurance plan between Nov. 1 and Nov. 25, while 30% opted to buy an ACA plan at full cost. During the first half of open enrollment for 2018 coverage, 56% of chose a short-term insurance plan, while 44% enrolled in an unsubsidized ACA plan.

The company had about 25,000 members in short-term plans at the end of the third-quarter, up 15% from a year ago, it told investors in October.

For people who don't qualify for federal financial help, short-term plans are less expensive than more robust ACA plans, though they don't have to cover people with pre-existing conditions and often don't cover certain essential health benefits, such as prescription drugs or maternity care. Some experts have warned that these "skinny" plans could harm consumers who don't understand the limitations of the coverage they are buying. Critics also fear the plans will siphon healthy people away from the individual market, causing premiums to spike for those who remain.

Beyond the cheaper price tag, the Trump administration's decision to zero-out the financial penalty for not purchasing health insurance coverage starting in 2019 is likely drawing more customers to the short-term policies. In the past, people who enrolled in short-term plans would have been subject to a fine because the ACA does not count the policies as satisfying its coverage requirement.

The Trump administration also made short-term policies more attractive to customers by allowing them to last up to 12 months, reversing an Obama-era rule that limited those policies to less than three months.

But eHealth has also made some marketing changes that could be contributing to the uptick. In April, eHealth CEO Scott Flanders told Modern Healthcare the company would begin promoting alternatives to ACA coverage, including short-term plans, rather than prioritize ACA-compliant plans, to reverse the decreasing market-share eHealth has experienced over the past few years.

Flanders anticipated "an avalanche" of interest in short-term plans in 2019 thanks to the Trump rule allowing insurers to offer longer lasting policies and the lack of the mandate penalty.

"While the major medical market remains challenged the short-term health insurance opportunity is attractive and allowed us to grow the total number of our approved members in the individual market over the same quarter last year for the second consecutive quarter," he told investors in October.

The average short-term plan premium among eHealth customers who enrolled in one was $107; those who enrolled in unsubsidized ACA plans faced an average individual premium of $477, according to the report. At the same time, people who enrolled in short-term plans faced an average deductible of $5,721—much higher than the average individual deductible for an ACA-compliant plan of $4,064.

Under the Trump rule, insurers can also allow consumers to renew their short-term plans for up to three years under the rule issued in August.

In an interview earlier this month, eHealth's senior director of carrier relations said most insurers the exchange works with have not included the option to auto-renewability in any plans currently available, but some insurers are considering new products to be launched at the beginning of 2019 that he expects to be auto-renewable.

Shelby Livingston is an insurance reporter. Before joining Modern Healthcare in 2016, she covered employee benefits at Business Insurance magazine. She has a master’s degree in journalism from Northwestern University’s Medill School of Journalism and a bachelor’s in English from Clemson University.

https://www.modernhealthcare.com/article/20181129/NEWS/181129912?utm_source=modernhealthcare&utm_medium=email&utm_content=20181129-NEWS-181129912&utm_campaign=dose

Illinois Legislature overrides veto of short-term health plan limit

By Stephanie Goldberg  | November 29, 2018

Illinois legislators Tuesday voted to override Gov. Bruce Rauner's veto of a bill that limits short-term health insurance plans, which are exempt from offering certain protections required under the Affordable Care Act.

S.B. 1737, filed by Democratic state Sen. Antonio Munoz of Chicago, limits the duration of so-called skinny plans to six months and requires them to notify consumers if policies do not qualify as minimum essential coverage for health insurance under the ACA.

Rauner vetoed the bill in August, saying Illinois "should look to be consistent with the regulatory structures of other states and the federal government, as further regulation will create barriers to Illinoisans' access to the health care plans that best fit their needs."

Short-term, limited-duration health insurance was designed as a temporary solution for individuals who are between jobs, for example. In 2016, to prevent such plans from being viewed as alternatives to more comprehensive medical coverage, the Obama administration imposed a three-month limit.

The Trump administration in August extended the initial period to less than 12 months and the maximum duration to less than three years, to "help increase choices for Americans faced with escalating premiums and dwindling options in the individual insurance market."

While premiums for short-term plans tend to be at least 20 percent less than the lowest-cost bronze plans available through the ACA marketplace, the majority don't cover outpatient prescription drugs or substance abuse treatment, and none cover maternity care, according to an April analysis by the Kaiser Family Foundation, which examined short-term health plans offered through two major national online brokers.

Some states have passed laws to regulate short-term plans, and a handful—including New York and California—have banned them altogether.

"Short-term health insurance plans can hurt consumers by not providing full medical coverage and leaving patients with high medical bills," Democratic state Sen. Heather Steans of Chicago said in an email. "S.B. 1737 protects consumers and the insurance marketplace in Illinois."

Proponents of short-term plans say they increase access to care by providing buyers with more affordable options.

"Illinois Legislature overrides veto of short-term health plan limit" originally appeared in Crain's Chicago Business.

https://www.modernhealthcare.com/article/20181129/NEWS/181129919?utm_source=modernhealthcare&utm_medium=email&utm_content=20181129-NEWS-181129919&utm_campaign=dose

HHS finalizes long-awaited 340B drug price rule

By Virgil Dickson  | November 29, 2018

HHS on Thursday said it will allow a rule imposing ceiling prices on the 340B drug discount program to go into effect next year, after years of delays.

The long-postponed rule will go into effect on Jan. 1, instead of the earlier-announced July 1, 2019 date, according to a finalized rulemaking.

HHS has delayed the effective date of the ceiling price rule five times. The change will cap the prices drugmakers can charge hospitals that participate in 340B. The American Hospital Association and several other healthcare trade groups sued the agency this past fall to force it to finalize the regulations.

HHS has said in the past that it needed more time to consider additional rulemaking to replace the Obama-era regulation with one drafted by the Trump administration.

It has now changed its mind. "HHS does not believe that any further delay is necessary and is changing the effective date," the agency said.

In addition, HHS noted that the Jan. 1 start date will not interfere with any subsequent rulemaking it may release on 340B ceiling prices.

Both the American Hospital Association and 340B Health, also a hospital trade association, praised the move by HHS.

"The final rule issued today is a big step toward stopping drug companies from overcharging 340B hospitals, clinics and health centers," Maureen Testoni, interim president and CEO of 340B Health said in a statement.

Both groups urged HHS to move forward quickly with their plans to launch a ceiling price website to give providers the opportunity to check the prices they're paying. The agency said the site will be up shortly.

Virgil Dickson was reporting from Washington on the federal regulatory agencies. His experience before joining Modern Healthcare in 2013 includes serving as the Washington-based correspondent for PRWeek and as an editor/reporter for FDA News. Dickson earned a bachelor's degree from DePaul University in 2007.

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