Centene to divest two pharmacy businesses for $2.8 billion after legal woes

 Centene Corp said on Thursday it has agreed to divest two of its pharmacy businesses for about $2.8 billion, in line with the heath insurer's strategy to exit the pharmacy benefit management space.

In 2021, Centene had to shell out $144 million to settle claims by Ohio and Mississippi that it overcharged their Medicaid programs for pharmacy benefit management services.

Pharmacy benefit managers (PBMs) are companies that act as intermediaries between drug sellers, health plans and pharmacies to negotiate prices.

Centene will sell pharmacy solution organization Magellan Rx to Prime Therapeutics LLC, while its PANTHERx pharmacies will go to a consortium of private equity firms including The Vistria Group, General Atlantic and Nautic Partners.

Magellan Rx was a part of Centene's $2.2 billion acquisition of Magellan Health in 2021.

Centene said it expects to complete the sale of PANTHERx in the next two to four months and of Magellan Rx by the fourth quarter, with the net proceeds to be used for stock repurchases and debt reduction.

"These transactions demonstrate significant progress in our ongoing portfolio review ... we are confident this will position the company to effectively grow," newly appointed Chief Executive Officer Sarah London said in a statement.

Each of the transactions is expected to be neutral to slightly accretive to Centene's adjusted earnings per share in the 12 months after the deal closes.

https://sports.yahoo.com/centene-divest-two-pharmacy-businesses-134138192.html

S.Africa's Aspen to slash COVID vaccine capacity within 6 weeks if no orders

 Aspen Pharmacare will switch about half of its COVID-19 vaccine production capacity onto other products if demand doesn't pick up within six weeks, its CEO warned, as South Africa's president and health officials urged more Africans to take up the shots.

Aspen APNJ.J completed a deal in March to package, sell and distribute Johnson & Johnson's JNJ.N COVID-19 vaccine in what was considered a game-changing moment for an under-vaccinated continent frustrated by sluggish Western handouts.

However, while only a sixth of adults in Africa are fully vaccinated, according to the latest World Health Organization figures, expectations of high demand for the South African firm's own-brand version of the shot have proved misplaced.

Aspen said on Saturday it had not received a single order for its Aspenovax vaccine.

https://www.userwalls.com/n/africa-aspen-slash-covid-vaccine-capacity-weeks-orders-ceo-3182890/

'How did we catch it?' Spread of Covid-19 baffles locked-down Shanghai residents

 Veronica thought she did everything right by sticking to all of the Covid-19 lockdown rules in the Chinese city of Shanghai.

After the entire city was shut down on April 1, her family of four scrupulously followed government orders to stay at home, stepping out the front door only for mandatory PCR testing.

When curbs were relaxed slightly in mid-April, letting residents walk about within their compounds, Veronica and her neighbours all wore masks.

For weeks, their housing estate was free of Covid.

But in late April, after what Veronica thinks was her 12th PCR test, she, another member of her family, and a handful of neighbours tested positive.

"I have no idea how we caught it," said Veronica, who declined to give her full name, citing privacy.

Her building was declared "sealed". She, her family and the others who tested positive were sent into quarantine. Everyone else was ordered back indoors for another 14 days.

"I followed all the rules," Veronica said from a quarantine centre where she and her family are confined with hundreds of people in a vast hall.

Veronica is among thousands who have caught Covid in compounds that had been free of the coronavirus and sealed off for weeks.

The cases underscore how difficult it is to stop the spread of the highly transmissible Omicron variant as China clings to its zero-Covid policy, perpetuating a cycle of lockdowns, as well as bafflement, anguish and anger.

Between April 21 and May 2, residents at 4,836 different addresses found themselves in a similar situation, with infections cropping up after weeks in the clear, according to a Reuters examination of Shanghai government data.

On April 30 alone, 471 addresses were recorded as having found at least one case, after registering none at all in the previous 29 days. The number of residents at a given address varied from a handful to hundreds.

Shanghai's lockdown measures have been extremely strict, especially during the first two weeks of April, with residents allowed out of compounds only for exceptional reasons, such as a medical emergency. Many are not even allowed out of their front doors to mingle with neighbours.

Shanghai's daily case numbers have come down for six straight days but the thousands of new ones still being found every day drive speculation about how COVID is spreading, debate over the wisdom of the "zero-Covid" policy and fear of infection.

Searching for answers, many residents point to queuing for the all-to frequent PCR tests, or deliveries of food and other items, which all rely on volunteers, property management staff and couriers.

Some people have even begun to refuse PCR tests, bringing penalties for failure to comply.

The Shanghai government, asked for comment, referred to remarks on April 14 by city health official Wu Huanyu, who said that infection through the distribution of supplies could not be ruled out, among other possibilities.

Health experts say the relentless spread points to China's difficulty in sticking to its zero-Covid goal.

"Their zero Covid policy works to a point but then they will keep getting hit hard, especially when they haven’t used that time to get high coverage of their most vulnerable population," said Paul Hunter, professor of medicine at the University of East Anglia, referring to China's relatively low rates of vaccination compared with other places.

Jaya Dantas, a public health expert at the Curtin School of Population Health in Australia, said China's approach had come with high costs, and to stamp out transmission completely would take months.

"They have been effective but really harsh with constant testing which is resource, labour and financially intensive. The mental health impacts on the population are also significant," she said.

Lockdowns in Shanghai and dozens of other cities have triggered rare public shows of discontent, especially as the persistent emergence of a relatively few infections prolongs the confinement of millions of others.

Each new case has multiple consequences: the Covid positive person and their close contacts must go into quarantine. All neighbours in their building must isolate for 14 days, with the clock resetting every time a new case is found.

Veronica says she has been scarred by the experience.

"Don't leave your apartment, but I don't even know if that helps anymore," she said.

https://www.asiaone.com/china/how-did-we-catch-it-spread-covid-19-baffles-locked-down-shanghai-residents

BridgeBio Shares Plunge After it Details Out-Licensing Plans For 'Restructuring'

 

• BridgeBio Pharma Inc 
  BBIO+ Free Alerts
   estimates between $23 million to $25 million in restructuring-related costs, including write-offs of long-lived assets, severance and employee-related costs, and exit and other related costs.
• “The restructuring initiative included, among other components, consolidation and rationalization of facilities, reprioritization of development programs, and the reduction of our workforce,” the company said.
• In March, BridgeBio sold off fosdenopterin, an injection drug for molybdenum cofactor deficiency (MoCD) type A, a rare genetic disorder, to Sentynl Therapeutics, netting $10 million upfront in the deal.
• The company is also looking to out-license six programs “due to the need to conserve capital and prioritize focused execution.
• Those programs include two drugs in clinical trials — one for dystrophic epidermolysis bullosa, a condition in which people are missing a collagen protein in a Phase 2 extension study, and a topical PI3KA inhibitor for venous lymphatic malformations in Phase 1/2 study.
• BridgeBio also said it plans to out-license its two preclinical AAV gene therapy programs – one for nonsyndromic hearing loss and one for classic galactosemia, an inherited condition in which people cannot digest a sugar found in milk. 
• The final two programs BridgeBio is hoping to out-license are also still in preclinical studies.
• The company held cash, cash equivalents, and marketable securities of $633.5 million, providing a cash runway into 2024.

https://www.benzinga.com/general/biotech/22/05/27029593/bridgebio-details-out-licensing-plans-for-its-restructuring-initiative

Biogen grabs MS music therapy from MedRhythms in $120m deal

 Biogen has licensed rights to a digital therapeutic (DTx) developed by MedRhythms which combines sensors, software, and music to help people with multiple sclerosis tackle mobility problems.

The biopharma company – which is one of the top players in MS drug therapies – is paying $3 million upfront to claim rights to the DTx, known as MR-004, and is also on the hook for an additional $117.5 million in development and commercial milestones plus royalties on any eventual sales.

The deal is something of a milestone for the digital therapeutics category, with the sums involved in the same ballpark as when biopharma companies license rights to promising drug-based treatments.

MedRhythms approach with MR-004 is based on rhythmic auditory stimulation (RAS), a neurological music therapy technique used to improve motor control in patients with various illnesses, including for example stroke survivors or people with Parkinson’s disease and cerebral palsy.

Using the approach, patients exercise alongside acoustic rhythms or music, trying to match their footsteps to the stimulus and improve their gait and mobility.

MedRhythms’ take on RAS is to include sensors in shoes that monitor gait, plus algorithms within a smartphone app that can modify the musical stimulus in response to how well the patient is performing the task.

The result is “closed loop” gait training that can produce clinical decisions similar to a trained therapist, according to the digital health specialist, which is also developing DTx for stroke, Parkinson’s and dementia patients as well as for fall prevention in the elderly.

MedRhythms is currently conducting two feasibility studies of MR-004, and, based on the readout of the first study, says it will start a registrational trial soon.

Biogen said that the licensing deal combines MedRhythm’s digital expertise with its “global footprint” in MS therapy, which comes from drug therapies like interferon beta-based injectables Avonex and Plegridy, infused antibody therapy Tysabri (natalizumab) and oral medicines Vumerity (diroximel fumarate) and Tecfidera (dimethyl fumarate).

Biogen’s MS franchise brought in more than $7 billion in sales last year, although it has started to shrink as a result of increasing competition in the market, particularly from generic rivals to Tecfidera.

“If approved, MR-004 has the potential to become the first prescription digital therapeutic for gait deficit in MS,” according to the two partners.

https://pharmaphorum.com/news/biogen-grabs-ms-music-therapy-from-medrhythms-in-120m-deal/

Only small amount of docs in some Medicaid managed care nets offer care to Medicaid

 Medicaid managed care services were primarily concentrated across few providers, prompting questions about network adequacy standards needing to be beefed up, a new study claims. 

The study, published Tuesday in the journal Health Affairs, comes as states are deferring more and more to managed care private plans to deliver certain benefits to eligible participants. The managed care space has also become a lucrative market for the insurance industry. 

“Our findings suggest that current network adequacy standards might not reflect actual access; new methods are needed that account for beneficiaries’ preferences and physicians’ willingness to serve Medicaid patients,” the study said. 

Researchers looked at data from four states from 2015 to 2017 to examine how many physicians in provider network directories of managed care plans participated in Medicaid. 

“We found that about one-third of outpatient primary care and specialist physicians contracted with Medicaid managed care plans in our sample saw fewer than ten Medicaid beneficiaries in a year,” the study said. 

It showed that 25% of primary care doctors delivered 86% of the care, while 25% of specialists on average provided 75% of medical care. 

The results come amid lingering issues with physician participation in Medicaid, which offers lower reimbursement rates than commercial plans, and concerns surrounding high rates of claim denials and long times to get payments, the study said. 

“Studies show that almost a third of office-based physicians do not participate in Medicaid—far fewer than participate in Medicare or commercial insurance markets,” the study said. 

The study’s sample comprised 22,056 physicians in adult and pediatric primary care, cardiology and psychiatry included in Medicaid managed care networks. 

“Overall, 16.3% of physicians listed in Medicaid managed care plan provider network directors in a year qualified as ghost physicians, meaning they saw zero Medicaid beneficiaries over the course of the year in an outpatient setting,” the study said. “The share of ghost physicians ranged from 13.4% to 24.9% across states.”

The specialty most likely to be a ghost physician was psychiatry with 35.5% of the population not seeing any Medicaid patients, while pediatric primary care physicians were least likely with only 11%.

Overall, the study showed provider network directors may overstate how many physicians can actually offer care to Medicaid. 

“Many states’ reliance on directories to ensure network adequacy may be insufficient to ensure satisfactory access to physicians who are both valued by Medicaid managed care beneficiaries and willing to treat them,” the study said. 

States are required by the federal government to demonstrate managed care network adequacy standards, but the government has been less explicit on how exactly states must do this. 

“States vary widely in the requirements of their network adequacy standards, oversight of those standards and penalties for overstating the breadth of networks,” the study said. 

Researchers recommended that states do more to evaluate managed care networks including via audits and claims-based assessments. Another recommendation was to explore penalizing plans that have physicians in their networks but don’t see Medicaid beneficiaries. 

https://www.fiercehealthcare.com/payers/study-only-small-amount-docs-some-medicaid-managed-care-networks-offer-care-medicaid

UnitedHealthcare rolls out new virtual physical therapy program

 UnitedHealthcare has partnered with Kaia Health on a new virtual physical therapy program.

The program aims to offer 24/7, on-demand exercise feedback to eligible members with musculoskeletal conditions, the health insurance giant said. Members who are recovering from surgery or an injury will be asked to complete an assessment of current issues and will be referred to the program based on that assessment.

Eligible members will then be able to download Kaia's app to access its physical therapy tools, which use artificial intelligence to support patients through physical therapy exercise and monitor progress.

The app tracks motion in real time to offer suggestions using the mobile phone's camera rather than a wearable device. In combination with self-reported data from the user, the app can identify when a member may need additional coaching or intervention to ensure they're meeting their physical therapy goals.

Russell Amundson, M.D., senior medical director at UnitedHealthcare, told Fierce Healthcare that the musculoskeletal space is a high priority for employer clients and a hotbed for potential innovation as these conditions represent a significant amount of healthcare spending and are quite common.

"It's a really important category not only in terms of the cost but how ubiquitous it is," Amundson said. "There's lots of treatment options and the best pathway for a particular patient is not always clear to them."

Participants in the program can also access one-on-one health coaching either telephonically or via the app's chat feature. These health coaches offer encouragement and guidance as well as a link to the patient's care team should they identify potential challenges.

The new virtual physical therapy option is part of UnitedHealthcare's broader push for greater virtual plan solutions and is available nationwide as an option for its self-funded employer clients.

Amundson said virtual therapy and other digital tools for MSK felt the telehealth boom under COVID-19, and, while use has decreased from pandemic highs, it remains elevated compared to pre-COVID levels.

https://www.fiercehealthcare.com/payers/unitedhealthcare-rolls-out-new-virtual-physical-therapy-program