Major Insurer Restricts Coverage Of Aduhelm
UnitedHealthcare says the drug is "unproven and not medically necessary." In other news on the health care industry, large not-for-profit health systems are recording windfalls from their investments that are offsetting significant operating losses.
Stat:
UnitedHealthcare Restricts Coverage Of Aduhelm, Following Medicare
UnitedHealthcare is restricting insurance coverage of Aduhelm across all of its health plans, saying the drug “is unproven and not medically necessary for the treatment of Alzheimer’s disease due to insufficient evidence of efficacy,” according to the company’s new policies. Physicians who plan on giving Aduhelm to UnitedHealthcare patients will need to obtain prior approval from the insurance company, effective June 1. Patients also need to be in an approved clinical trial. (Herman, 5/2)
Modern Healthcare:
UnitedHealthcare To Limit Aduhelm Access
UnitedHealthcare will restrict coverage of Biogen's Aduhelm, the nation's largest health insurance company notified providers Sunday. The UnitedHealth Group subsidiary will only cover the costly Alzheimer's disease treatment also known as aducanumab for patients enrolled in clinical trials and will require prior authorization. The medication is "unproven and not medically necessary for the treatment of Alzheimer's disease due to insufficient evidence of efficacy," the insurer wrote in bulletins sent to providers. The rules apply to the insurer's commercial, individual and Medicare members and take effect June 1. (Tepper, 5/2)
Meanwhile —
The Wall Street Journal:
Cerebral’s Preferred Pharmacy Truepill Halts Adderall Prescriptions For All Customers
Online pharmacy company Truepill Inc. said it is temporarily halting prescriptions for Adderall and other controlled substances used to treat attention-deficit hyperactivity disorder, and partner Cerebral Inc. told its clinicians to direct those orders to patients’ local pharmacies. Cerebral, an online mental-health company based in San Francisco that describes Truepill as its preferred pharmacy, informed its clinicians of Truepill’s decision in a Friday email viewed by The Wall Street Journal. The email said Truepill would no longer support mailing Schedule 2 controlled substances, including Adderall and Vyvanse, “to any of their customers.” (Winkler, 5/2)
Modern Healthcare:
Stanford Health Nurses Approve Contract, Will End Weeklong Strike
Stanford Health Care and Stanford Children's Health nurses have agreed to a three-year contract following a strike that began a week ago, the union said Monday. Nurses will return to work Tuesday. Members of the Committee for the Recognition of Nursing Achievement, or CRONA, on Sunday voted 83% in favor of the contract, the union said. The union represents 5,000 nurses employed by the southern California hospitals. The union disclosed a tentative agreement Saturday. (Christ, 5/2)
On industry financial matters —
Modern Healthcare:
Not-For-Profit Hospitals' Investment Income Covers Operating Losses
Large not-for-profit health systems are recording investment income windfalls that are offsetting significant operating losses. St. Louis-based Ascension recorded a $640.1 million operating loss on $19 billion in revenue through the first nine months of its 2022 fiscal year, according to the 142-hospital system's earnings statement released Friday. Nearly $900 million in non-operating income, $736.4 million of which was attributable to investment income, more than offset those losses. That was down from nearly $4.5 billion in non-operating gains in the same prior-year period. (Kacik, 5/2)
AP:
WVU Receiving $11M For Research On Visual Disabilities
West Virginia University is receiving $11 million in federal dollars for research on treating and slowing the progression of incurable eye diseases. West Virginia has the second-highest rate of visual disability in the U.S., according to a university news release. A visual disability is a disability that cannot be treated with corrective glasses. “The idea is to think collaboratively,” West Virginia University biochemistry Chair Visvanathan Ramamurthy said. “How can we make change? How can we translate our basic science findings to clinical practice that helps people?” (5/3)
Bloomberg:
Astorg Agrees $2.6 Billion Acquisition Of ICIG’s CordenPharma
Astorg Partners will acquire contract drug development and manufacturing company CordenPharma, in one of the year’s largest private equity deals in European health care. The French private equity firm is buying the business from International Chemical Investors Group, according to a statement Monday that confirmed an earlier Bloomberg News report. Under the terms of the deal, CordenPharma’s founders will reinvest as partners with Astorg. (Foerster, Henning and Nair, 5/2)
Modern Healthcare:
Optum's $236 Million Atrius Health Deal Scores Final Regulatory Approval
Massachusetts' highest court approved UnitedHealth Group subsidiary Optum's $236 million proposed acquisition of Atrius Health, one of the largest not-for-profit physician groups in the state. Massachusetts Supreme Judicial Court Justice Dalila Argaez Wendtland ruled the proposed transaction was in the public interest and that it was impracticable for Atrius to continue to operate as a not-for-profit. Atrius Health had been struggling financially. The state attorney general approved the decision in late April and, with Friday's judicial review, the companies have completed all the legal steps necessary for the deal to go forward. (Tepper, 5/2)
