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Anthem Files Answer to Suit

Anthem has filed in Court in Washington D.C.  its Answer to the government’s Complaint.  The Company has responded line by line to the Complaint.

Everyone in America has an interest in how this will turn out.

Every American is somewhere in the healthcare spectrum, at some point: either a policyholder, a patient, a medical care provider, a pharmacy, a medical equipment provider, a healthcare employee, a medical equipment manufacturer, a drug manufacturer, a government agency charged with looking out for the benefit of the American people, or an insurance carrier.  To read Anthem’s Answer that has been filed, click here.

VA Same Day Appts Coming

“Veterans will have same-day access to primary care appointments and mental health services at Veterans Affairs facilities by December, VA Secretary Bob McDonald promised Tuesday.

Addressing the Veterans of Foreign Wars national convention in Charlotte, North Carolina, McDonald said veterans wait an average of five days for primary care, six days for specialty care and two for mental health services, but VA plans to reduce those further by the end of the year.”  Source: Military Times.  For details click here.

New FDA Safety Alert

“According to a July 26 released FDA advisory these medications have been associated with disabling and potentially permanent side effects involving tendons, muscles and/or joints, as well as peripheral nerves and the central nervous system. Some patients may even experience more than one such adverse effect.

“Therefore, said FDA officials, fluoroquinolones should be used in patients with acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB) or uncomplicated urinary tract infections (UTIs) only when no other treatment options are available, “because the risk of these serious side effects generally outweighs the benefits in these patients.”

“Fluoroquinolones have risks and benefits that should be considered very carefully,” said Edward Cox, M.D., director of the Office of Antimicrobial Products in the agency’s Center for Drug Evaluation and Research…”  Source:  American Academy of Family Physicians.  For details click here.

Still Working on a Solution

There is work still being done getting new legislation in the works to protect the Social Security program for Americans.

“Mitch Daniels, the former Republican governor of Indiana, and former Sen. Kent Conrad, D-North Dakota, are among the former elected officials from both parties that sit on the Committee for a Responsible Federal Budget’s board of directors. Officials from each administration dating back to the Nixon presidency, including Paul Volker, Erskine Bowles, Paul O’Neil and Peter Peterson are also among the directors.”

Something has to be done to maintain the program. Many many Americans have to rely on their Social Security income only. Americans are living longer and working longer- generally 20 years or so after 65 and that was not the case when Social Security was originally set up. Times have changed. It is disheartening that there has to be some tough decisions made, but we feel strongly that if Indiana’s own Mitch Daniels is involved in the decision process- there is hope for the best possible solution.  For more details, click on the link below:


Indiana Sets The Record Straight

As of January 2016, there were 345,656 HIP 2.0 enrollees in Indiana. HIP 2.0, which is the Healthy Indiana Plan 2.0, is similar to Indiana’s original HIP coverage that was successfully geared as a low-cost option for low-income households in Indiana.

Indiana has been permitted by HHS to use HIP 2.0 as it’s Affordable Care Act Medicaid expansion.

During the first year of the HIP 2.0 program, 2,677 individuals at 101- to 138% of the Federal Poverty Level were dis-enrolled from HIP and not allowed to return for six months for failing to pay their monthly contribution to their “Power Account,” which basically serves as their premium for the coverage.

The state revealed 21,445 Medicaid members transitioned back to the basic plan of coverage, which does not include dental and vision, due to nonpayment of their monthly contributions. This basically is admitting that some insured members who were already in the actual Medicaid program prior to being enrolled in HIP 2.0 did not make their monthly contributions to their accounts.

According to the article in Modern Healthcare, affordability was not the leading reason for people not making their monthly contributions. Instead, most cited confusion over the fact that they needed to make a payment, or when the payment needed to be made.

As reported by the independent Lewin Group who studied the results of HIP
2.0, “It appears that Power account (monthly) contributions do not constitute a barrier to enrollment in the HIP program.”

74% of HIP 2.0 beneficiaries said they were able to get routine care as soon as they needed it and nearly 80% had no trouble getting access to specialists. Overall, 58% of members reported that they were very satisfied with the new Medicaid program, while an additional 22% said they were somewhat satisfied. Source: Modern Healthcare.

Humana Announces ACA Reduction

“Starting in 2017, Humana will only sell individual plans in 11 states, compared with 19 states for this year, the Louisville, Ky.-based insurer said in a release Thursday. The ACA retreat was revealed in a company update to increase its profit estimates for the year.

“The reduction is even starker at a local level. Humana’s individual plans will be offered in “no more than 156 counties” next year, compared with 1,351 counties this year. Humana expects to collect anywhere from $750 million to $1 billion in premiums from its individual ACA plans in 2017, a reduction of almost 80% from the $3.4 billion premiums projected for 2016.

“Humana pre-recorded a $176 million loss on 2016 ACA plans in February, and the insurer added another $208 million in expected losses Thursday…

“Humana, like its for-profit competitor UnitedHealth Group, enrolled many people who were sicker than originally expected. UnitedHealth will participate in no more than three ACA marketplaces for 2017.

“The individual market represents a small fraction of revenue for Humana and UnitedHealth.”  Source: Modern Healthcare

DOD Changes Tricare Insurance

“The U.S. Department of Defense has awarded multiyear contracts worth $58 billion to Humana and Centene Corp. to manage Tricare, surprisingly booting incumbent health insurer UnitedHealthcare in the process…

“In 2014, the Defense Department and Defense Health Agency decided to alter the structure of the Tricare program, which provides health coverage for U.S. military members and their families. Instead of dividing Tricare into three regions (North, South and West), the government wanted to consolidate to two coverage areas (East and West).

“Humana, which had managed the South region, will now provide coverage for 6 million Tricare members in the new 32-state East region, essentially absorbing most of UnitedHealthcare’s members. Centene will gain the 21-state West region, which covers about 3.4 million people. Iowa, Missouri and Texas will include both companies.

“The contracts are expected to start April 2017, pending the appeals process.”  Source:  Modern Healthcare.

Dept. of Justice Has Filed Lawsuits

“The U.S. action is “an unfortunate and misguided step backwards for access to affordable healthcare for America,” Anthem said. “The DOJ’s action is based on a flawed analysis and misunderstanding of the dynamic, competitive and highly regulated healthcare landscape and is inconsistent with the way that the DOJ has reviewed past healthcare transactions. ”

“Cigna said it was “evaluating its options consistent with its obligations under the agreement” and said it doesn’t expect the transaction will close in 2016. “The earliest it could close is 2017, if at all.”  Source:  Health Benefits Pro Alert.

Anthem, Cigna, Aetna, and Humana all have strong suits as an insurance company such that, if merged and administered properly, could be beneficial to the market and to consumers.  The battle for increased competition has already been lost in Indiana and Kentucky with the Affordable care Act law.  It seems there is a need now to focus on efficiency among the insurers that do exist.  We will continue to watch this news at it develops.

Generic Rx for Crestor May Be Coming

“Pharmaceutical giant AstraZeneca failed to block approval of generics for its best-selling cholesterol drug after a federal judge tossed out the company’s request.

“A federal judge in Washington, D.C., denied the drugmaker’s request Tuesday for a temporary restraining order against the Food and Drug Administration in an attempt to prevent generic manufacturing of its drug Crestor. The ruling allows generic companies to officially manufacture generics of the drug.

“In an emailed statement, AstraZeneca said, “While we are disappointed with this decision, we appreciate the court’s careful consideration in addressing these important issues. We are currently assessing our options.”  Source: Modern Healthcare

Justice Dept. Continues Against Anthem & Aetna

“Officials with the antitrust division of the U.S. Department of Justice likely will file lawsuits this month to block Anthem’s $53 billion acquisition of Cigna Corp. and Aetna’s $37 billion deal for Humana…

“Federal intervention would overturn the rulings of many state insurance departments, most of which have approved the mergers…

“Both deals have faced immense scrutiny from hospitals, doctors and consumer groups in the 12-plus months since they were announced. Critics have argued the pursuits of Aetna and Anthem to bulk up would result in higher premiums and anti-competitive behavior. But the CEOs of Aetna and Anthem each have said their respective deals would lower healthcare costs and balance out the effects of increased consolidation among hospitals and health systems.  Source: Modern Healthcare.  For more details, Click Here.