About health insurance/insurers
Man charged in $70M Medicare fraud scheme “A Mississippi man faces up to 25 years in prison for his alleged role in a Medicare fraud scheme exceeding $70 million…
Prosecutors claim he used the companies to bill Medicare for orthotic braces obtained by the use of fraudulent physician orders, which were generated by contacting Medicare beneficiaries and obtaining personally identifiable information through call centers. The indictment alleges that kickbacks and bribes were also used to obtain medical providers' signatures, generating the fraudulent physician orders. Mr. French also allegedly paid for physicians' orders for orthotic braces that were then sold to suppliers and brokers in exchange for millions in kickbacks and bribes.”
Comment: Never ceases to amaze me how Medicare lets this magnitude of fraud get by for so long.
Are employees getting fed up with high-deductible health plans? “According to ValuePenguin, a financial resource platform by LendingTree, HDHP enrollment has dropped by 2%, the first decline since 2013. While nearly 56% of American private-sector workers were enrolled in HDHPs as of 2021, that number fell to just under 54% in 2022, marking a small but possibly significant shift in U.S. healthcare. Overall, 32 states saw decreased HDHP enrollment…
Notably, large employers seem intent on offering a more diverse array of health plans. In 2018, 22% of employers with 20,000 employees or more offered only HDHPs — that number dropped to 9% in 2022….
According to exclusive research by EBN's parent company Arizent, employees with HDHPs are 30% less confident they will know what their healthcare costs will be, at least most of the time, compared to employees with preferred provider organization plans, or PPOs, which usually have lower deductibles. Unsurprisingly, Arizent found that 70% of HDHP users found their healthcare costs too expensive, versus 50% of PPO users.”
About pharma
Roche touts near-complete suppression of multiple sclerosis relapse for injectable Ocrevus “One-year data continued to support a more convenient, injectable version of Roche’s blockbuster multiple sclerosis (MS) drug Ocrevus ahead of an FDA decision, the Swiss pharma said.
A subcutaneous formulation of Ocrevus helped 97% of MS patients achieve no relapse up to 48 weeks of treatment, according to updated data from the phase 3 OCARINA II study presented at the American Academy of Neurology (AAN) annual meeting.
Besides lowering the annual relapse rate to an estimated 0.04, subcutaneous Ocrevus also suppressed brain lesions as shown on MRI imaging by 97%. Most patients had no T1 gadolinium-enhancing lesions or worsening T2 lesions, which are markers of active inflammation and burden of disease, respectively.”
Top 15 specialty pharmacies by 2023 revenue FYI
AbbVie links up with Medincell for $2B injectables deal “AbbVie said Tuesday it will pay Medincell $35 million upfront to co-develop up to six therapies using the latter’s BEPO platform for long-acting injectables.
Medincell is eligible for up to $315 million in development and commercial milestones for each programme, for a total of $1.9 billion, plus mid-single- to low-double-digit royalties.
While the pharma said the partnership covers “multiple therapeutic areas and indications,” details were sparse on whether the injectable therapies will be reformulations of existing AbbVie drugs, or novel therapeutics.
Medincell’s platform enables bioresorbable delivery of a drug at therapeutic levels for several days, weeks or months from one injection.”
Takeda bets up to $1.2B on Kumquat's immuno-oncology candidate “akeda has entered into a strategic collaboration and exclusive global licensing agreement with Kumquat Biosciences potentially worth over $1.2 billion to develop and commercialise an oral immuno-oncology small molecule inhibitor.
As part of the deal announced Tuesday, Kumquat will receive up to $130 million in near-term payments from Takeda. It is also eligible for over $1.2 billion in future clinical, regulatory, and commercial milestones, as well as tiered royalties on net sales of any approved products resulting from the tie-up.
Kumquat will lead research efforts and fund early clinical development through Phase I testing of the undisclosed cancer candidate, which can be developed as a monotherapy or in combination with other drugs. Subject to Kumquat's option, Takeda will assume and fund all development and commercialisation activities beyond Phase I activities led by the San Diego-based biotech.”
Sandoz bucks trend with “explosion” in US prescriptions for Humira biosimilar “CVS Caremark’s decision to replace AbbVie’s Humira (adalimumab) with biosimilar versions of the anti-TNF-α monoclonal antibody has led to a recent “explosion” in new prescriptions for Sandoz’s Hyrimoz (adalimumab-adaz). The numbers, detailed in a recent analyst note from Evercore ISI, signal that biosimilars may be able to finally break Humira's market dominance in the US.
Humira lost patent protection in the US at the start of 2023 and currently faces competition from nine biosimilars, including interchangeable versions in Boehringer Ingelheim's Cyltezo (adalimumab-adbm) and more recently Teva/Alvotech's Simlandi (adalimumab-ryvk). However, Evercore ISI analysts noted that as of the end of March, AbbVie’s drug still held on to around 95% market share for new prescriptions.”
About the public’s health
New long-term data show Shingrix continues to provide high protection against shingles in adults aged 50 and over for more than a decade Summary:
—”End-of-trial data show 79.7% efficacy in participants aged 50 years and over, six to 11 years after vaccination1
—Vaccine efficacy remains high at 82.0% at year 11 after initial vaccination1
—No new safety concerns were identified during the follow-up period.”
About healthcare personnel
New AACN Data Points to Enrollment Challenges Facing U.S. Schools of Nursing “New data released today by the show that sustaining student enrollment in baccalaureate and graduate programs continues to be a challenge at U.S. schools of nursing. Though enrollment in programs designed to prepare entry-level registered nurses held steady (up 0.3%), fewer students are entering baccalaureate degree-completion, master’s, and PhD programs, which poses a threat to meeting the nation’s healthcare needs.”
See the article for further details.
About healthcare finance
Private equity healthcare bankruptcies are on the rise: 8 things to know One interesting fact is that: “About 460 U.S. hospitals are owned by private equity firms. That represents 8% of all private hospitals and 22% of all proprietary for-profit hospitals… At least 26% of private equity-owned hospitals serve rural populations.”