Top Stories in Business & Health for May 15, 2017

Anthem terminates merger agreement with Cigna 

Anthem announced Friday that it would no longer pursue its merger with Cigna. “Cigna has failed to perform and comply in all material respects with its contractual obligations,” Anthem said in a press release. “As a result, Cigna is not entitled to a termination fee. On the contrary, Cigna’s repeated willful breaches of the merger agreement and its successful sabotage of the transaction has caused Anthem to suffer massive damages, claims which Anthem intends to vigorously pursue against Cigna.” On Thursday, a Delaware court denied Anthem’s request for a preliminary junction. The judge had stayed the implementation until today, allowing Anthem an opportunity to take its case to the Delaware Supreme Court. 

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Express Scripts offers program to lower drug prices for uninsured, underinsured consumers

In collaboration with eight leading drug companies, technology firm GoodRx and nearly 40,000 pharmacies, the nation’s top pharmacy benefit manager is offering a program called Inside Rx that provides lower prices on certain prescription drugs to people who are uninsured or those with high deductibles who otherwise would not be able to pay for their medications. Currently, the program includes 40 branded drugs to treat common illnesses such as allergies, asthma, cardiovascular conditions, chronic obstructive pulmonary disease, depression and diabetes. According to Express Scripts, consumers using Inside Rx can save an average of 34 percent on their medications.

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Sanofi outdoes other pharma firms with drug price pledge

French drug giant Sanofi announced that it would limit its U.S. price increases to the projected growth rate for national health expenditures, an overall health inflation measure the Centers for Medicare and Medicaid Services (CMS) calculates annually. The projected rate for 2017 is 5.4 percent. That’s considerably lower than the “single-digit” limits that some other drug companies have pledged since the industry came under scrutiny for its pricing practices. Sanofi also said it would report its aggregate price increases each year, including retail prices and net prices after discounts and rebates to payers. Industry leaders such as Johnson & Johnson and Merck released similar pricing reports earlier this year. For 2016, Sanofi’s average aggregate list prices rose 4 percent, while average aggregate net prices dropped 2.1 percent.

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ACA premiums to increase

Premiums for ACA health plans could increase at even higher rates next year, based on the first few states to release proposed rates, The Washington Post reported. Although many states have extended their deadlines for insurers to file 2018 plan prices because of the political uncertainty surrounding the Affordable Care Act, information released by three states and the District of Columbia reveals that insurers are looking for double-digit increases, some of which “far exceed” the average 25 percent increases for this year’s most popular ACA plans. For example, CareFirst Blue Cross Blue Shield, the largest insurer in the mid-Atlantic area, asked for average increases of 52 percent for health plans sold in Maryland and 40 percent for HMO plans sold in D.C. Anthem requested average rate increases of 38 percent in Virginia and 34 percent in Connecticut. Senate Republicans pointed to the proposed hikes as further evidence of the need to repeal the ACA—even though the turmoil resulting from the repeal efforts is fueling the uncertainly that’s causing the rate increases. 

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Potential changes in wage and overtime rules 

Senate Republicans are crafting a bill to reverse a 2015 regulation that extended Department of Labor (DOL) minimum wage and overtime protections to home care workers, Bloomberg BNA reported. An estimated 2 million employees who provide in-home care for the elderly and the disabled gained basic wage protections when the DOL eliminated what is commonly referred to as the “companionship exemption” in 2015. Sen. Pat Roberts, R-Kan., said the new Senate bill is a back-up plan in case the DOL, under the leadership of newly appointed Secretary of Labor Alexander Acosta, decides not to restore the exemption. 

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Also…

Aetna is pulling out of the last two states in which it offers plans on the ACA exchanges—Delaware and Nebraska—so the payer has completely exited the Obamacare program. As a result, residents in both states will have one carrier to choose from on the exchanges. Earlier this year, the nation’s third-largest health insurer announced that it would exit Iowa and Virginia.

The Blue Cross Blue Shield Association (BCBSA) and Lyft announced a national partnership for ride-share services at no cost to patients who otherwise can’t afford transportation for doctor visits. BCBSA said the partnership is “an effort to address the community effects of social determinants of health … to ensure Americans are not missing vital health care appointments simply because they lack reliable transportation.”

Geisinger signed a letter of intent to create a clinical joint venture with Highmark Inc. Geisinger said the agreement allows the two payer-providers to explore the joint venture in greater detail. The clinical network will be focused on Highmark and Geisinger heath plan members in north central Pennsylvania.