UnitedHealth will use Praluent as cholesterol-lowering drug

Modern Healthcare

  • UnitedHealth Group will use Praluent, one of two new federally approved cholesterol-lowering drugs, in its formularies. Sanofi and Regeneron Pharmaceuticals make the PCSK9 inhibitor, which treats patients who have high cholesterol levels but don't respond to statins. Insurers usually receive discounts for placing drugs on the preferred tier, which drives use. The retail price for Praluent is $14,600 annually, while its competitor, Repatha, costs $14,100. The Institute for Clinical and Economic Review, a not-for-profit research group, said the prices for Praluent and Repatha would have to drop by more than 80% to be a good deal for the healthcare system and patients.

  • The Medicare Payment Advisory Commission unanimously backed recommendations that would reduce Medicare Advantage plan reimbursement by at least $200 million. The suggestions involve allowing the HHS secretary to eliminate benchmark caps and the “double bonuses” now received by Medicare Advantage plans. The current payment formula uses outdated spending calculations from 2010, according to Scott Harrison, a principal policy analyst at MedPAC. The Affordable Care Act allows some counties to receive double quality bonuses if they are in metropolitan areas with at least 250,000 people. About 19% of Advantage enrollees are in double-bonus counties, and 19% are in capped counties. MedPAC will formally vote on the recommendations in January and present its findings to Congress by March.

  • A judge has ordered HCA to pay almost $434 million to the Health Care Foundation of Greater Kansas City for failing to follow through on promises made more than a decade ago when it bought the assets of one of the region's largest hospital systems. In 2003, Nashville-based HCA purchased Health Midwest, based in Kansas City. The deal required HCA to make at least $450 million in capital improvements during its first five years of ownership and provide the region with $653 million a year in charity care over 10 years. The foundation, created after the deal, filed a lawsuit against HCA in 2009 alleging it failed to keep its agreement.
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