This is Jacob Emerson with the Becker's Payer Issues podcast. Here is your biweekly industry news briefing for August 28th. Centene will no longer pay commission to insurance brokers enrolling or renewing members in its Medicare Part d plans. In a message sent to brokers on August 25th, Centene said it will continue paying compensation to brokers enrolling members in its WellCare Medicare Advantage
Plans. In its message, Centene said the inflation reduction act has resulted in significant changes to Part d. Company wrote that to continue providing access to high quality health care and Part d coverage that helps families and individuals, we have made the difficult decision that effective January 1, 2025 to cease new and renewal commissions for prescription drug plans beginning with the 2025 plan year.
In 2024, provisions of the IRA that eliminated co pays for party beneficiaries who enter the catastrophic phase of coverage took effect. In 2025, a $2,000 out of pocket spending cap will apply to part d members. Medicare Advantage and Part d plans pay brokers compensation for new enrollments and renewals in their plans.
The National Association of Benefits and Insurance Professionals said in an August 27th statement that the decision to cut commissions threatened not only the livelihoods of Medicare agents, but also the communities they serve and the seniors who rely on their expert guidance. Centene was the 4th largest Part d plan sponsored in 2023. The company had 6,600,000 Part d members as of June. Well, Cigna is removing Humira from its largest commercial formularies in 2025.
Express Scripts will have several biosimilar alternatives to the biologic drug available through its formulary. A new Humira biosimilar is available for $0 for patients of Cigna's Accredo specialty pharmacy. Express Scripts is the 2nd major PBM to replace Humira with its biosimilar competitors following CVS Caremark replacing Humira with biosimilars from its main formularies on April 1.
Well, CMS dropped a proposed regulation that would have required Medicare Advantage Plans to return overpayments found during chart reviews, amid industry opposition. That's according to a KFF report on August 27th. In 2014, CMS proposed a rule that would have required health plans reviewing patients' medical records to identify potential overpayments and return them to the agency. CMS dropped the proposed rule later that year after pushback from payers.
Records released from a 2022 deposition show that CMS officials decided to abandon the rule after concern from insurers, and the rule change was at the center of a civil fraud case against UnitedHealth Group that has been pending for more than a decade. In those records recently made public, CMS officials said they decided not to move ahead with the regulations because of, quote, stakeholder concern and pushback.
The case was filed in 2,011 by a former UnitedHealth employee and was taken over by the justice department in 20 17. The DOJ is alleging that it paid UnitedHealth $2,100,000,000 between 2,009 and 2016 for unsupported billing codes, which it says United should have removed. But because the proposed rule was not finalized, UnitedHealth said in court rulings it should not be penalized for failing to follow a regulation that CMS did not adopt.
Well, Aetna will cover intrauterine insemination as a medical benefit for eligible plans, a move the insurer called a, quote, landmark policy change. Intrauterine insemination or IUI is usually only covered if employers offer a separate fertility benefit plan. This new change from Aetna will apply to fully insured commercial plans. Back in May, Aetna settled a lawsuit alleging its fertility coverage policies discriminated against LGBTQ plus couples.
As part of that settlement, Aetna said it would introduce a new health plan that includes artificial insemination as a standard benefit for all members regardless of sexual orientation. The company said it will also take steps to ensure its covered its coverage policies for in vitro fertilization are not more burdensome for LGBT couples than heterosexual couples. Fertility treatments are often not covered by insurance.
In 2017, 23% of employers with more than 500 employees covered IUI, and 35% of employers with more than 2,000 20,000 employees covered the treatment. And finally, Elavance Health is reportedly no longer among the potential purchasers of Evolent Health. That's according to exclusive reporting from Reuters.
On August 22nd, Reuters had reported that Elavance was considering purchasing the health care software company, and sources familiar with the deal told Reuters on August 26th that the company had dropped out of that process. Evolent Health, launched by UPMC Health Plan, creates software to help providers transition from fee for service to value based arrangements.
If you'd like the latest health insurance industry news delivered straight to your inbox every morning, subscribe to the Becker's payer issues e newsletter on our website atbeckerspayer.com.