Jul. 25, 2014, 11:05 AM| 2 Comments
Jul. 3, 2014, 11:07 AM
- Saying that most custom-mixed medicines are either ineffective or overpriced, pharmacy benefit manager Express Scripts (ESRX +0.6%) plans to drop coverage for 1,000 drug ingredients found in compounded meds. The company states that the move will reduce employers' spending on compounded prescriptions by 95%. Express Scripts SVP Glen Stettin says, "What we are eliminating is, pure and simple, wasteful spending. These drugs are being used when there are other things available that are already approved by the FDA and are less expensive." The cuts will take effect on September 15, 2014 unless customers specifically ask to continue paying for them. Firms who want to opt out of the cuts must notify ESRX by Thursday (not sure if this means today).
- Predictably, compounding pharmacists lack enthusiasm for the move saying that it will deprive patients of much-needed medications.
- Related tickers: (UNH +0.7%) (CTRX +0.4%) (BIOS -0.2%) (WLP -0.7%) (AET +0.3%) (CI +0.6%) (HUM +0.2%) (CNC) (WCG +0.3%) (MOH +1.4%) (MGLN +0.5%)
Jun. 4, 2014, 9:43 AM
- AstraZeneca (AZN +0.2%) and Cigna (CI) -0.1%) ink a deal whereby the insurer will use predictive modeling software to authorize paying for Crestor instead of relying on prior authorization. Cigna says that it will lower drug costs because the Big Data-based model will flag patients most at risk for atherosclerosis and will approve the immediate use of Crestor instead of following the traditional "step therapy" rule requiring the patients to try cheaper drugs first. It is also a win for AZN because it will be CI's brand-name statin. The initiative should help support sales before the product goes off patent in 2016.
May. 1, 2014, 9:52 AM
- Cigna's (CI +3.5%) net profit jumped to $528M from $57M a year earlier, when the health insurer took a major charge for a reinsurance transaction.
- Global health-care: premiums and fees +2.9% to $5.99B, adjusted margin slips to 6.6% from 6.7%.
- Disability and life-insurance: premiums and fees +6.7% to $916M, adjusted margin grows to 6.7% from 5.2%.
- Total medical customers edges up to 14.2M from 14.1M a year earlier and from almost 14.1M in Q4.
- Increases FY EPS guidance to $7.05-7.35 from a prior outlook of $6.80-7.20 a share. Cigna also expects consolidated adjusted income from operations of $1.93-2B.
- Analysts predict FY EPS of $7.17. (PR)
May. 1, 2014, 6:13 AM
Apr. 30, 2014, 5:30 PM
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Apr. 17, 2014, 7:41 AM
- In response to insurers' reticence over covering behavioral interventions, California tightens its rules over insurance coverage for autism to improve access to treatment. Now, coverage must be on par with doctor visits despite the fact that most therapies are administered by non-M.D.'s.
- (AET) (HNT) (HUM) (UNH) (WLP) (MOH) (CI)
Apr. 4, 2014, 8:06 AM
- New York joins 12 other states restricting out-of-network heath care providers from billing patients for the difference between their charges and the insurer's reimbursement.
- This happens most frequently in emergency cases where patients are unable to choose their doctors.
- The Affordable Care Act doesn't address this specific problem but stipulates network adequacy requirements so patients have a greater probability of having a network clinician treat them.
- The problem is complex due to the wide range of reimbursement rates.
- (AET) (HNT) (HUM) (UNH) (WLP) (MOH) (CI) (WCG)
Mar. 24, 2014, 7:27 PM
- As U.S. corporations sit on $1T-plus in cash and with many facing organic growth challenges, Morgan Stanley lists 44 multi-billion dollar cap companies it thinks have a high likelihood of receiving at least one tender offer over the next 12 months.
- In the energy sector: NFX, SD, TDW.
- In materials: CLF, AXLL, UFS, RGLD.
- Consumer discretionary: SBGI, WEN, TPX, EAT, BYI, DWA, JCP, AEO.
- Consumer staples: INGR, HAIN, HSH, WWAV.
- Health care: CELG, ESRX, WLP, REGN, ALXN, AET, CI, BDX, CERN.
- Financial: NSM.
- Tech: BRCD, ONNN, TIBX, SPWR, IM, JBL, SUNE, TER, ARRS, NSR.
- Telecom: CCI, SBAC, LVLT, WIN, FTR.
Feb. 26, 2014, 4:46 PM
Feb. 7, 2014, 8:49 AM
- Cigna (CI) -3.9% premarket after Q4 earnings dropped 11% as global health care margins slipped and it lost members from the prior quarter.
- Issues downside guidance for FY 2014, seeing EPS of $6.80-$7.20 vs. $7.32 analyst consensus estimate.
- The global health care segment, CI's largest, posted 6% higher premiums and fees; adjusted margin in the division fell to 5% from 6.7%, reflecting higher medical costs in its Medicare Advantage business.
- Premiums and fees revenue rose 6.7% to $7.28B; total overall revenue gained 7% to $8.15B.
- Total medical customers rose 1.2% to 14.22M from 14.05M a year ago, but fell from 14.3M in Q3.
Feb. 7, 2014, 6:01 AM| Comment!
Feb. 7, 2014, 12:05 AM
Feb. 6, 2014, 5:30 PM
Dec. 11, 2013, 12:08 PM
- "Any hopes of a roll-back of the 2% Medicare sequestration cuts were dashed as more details of the plan were revealed over the course of the evening," Deutsche's Scott Fidel notes, referencing the new U.S. budget agreement.
- "In fact," Fidel continues, "under the budget deal the 2% Medicare payment cuts will actually be extended by two years through 2023."
- Nevertheless, Deutsche doesn't think anyone was expecting much in the way of a roll-back anyway, and as such, the bank sees limited impact for MCO names.
- AET, CI, HNT, HUM, UNH, WLP
Nov. 25, 2013, 3:40 PM
- "Because the President is looking for MCOs to work with the Administration in smoothing out the transition to the ACA, there is increasing investor perception that the sector may be to obtain some concessions in exchange for its help," UBS' A.J. Rice says, in a note on the managed care space.
- Rice likes Aetna (AET +1.2%) and Cigna (CI +1.4%) based on "strong visibility on future growth, limited ACA exposure, [and] company specific catalysts," while UnitedHealth (UNH +0.3%) is also Buy-rated.
- Price targets: AET, $82 (from $76); UNH, $84 (from $81); ELP $98 (from $87); HUM $95 (unchanged).
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