Health Brief: Cigna to Acquire Express Scripts for $54 Billion

Top Stories

  • Cigna Corp. has agreed to acquire Express Scripts Holding Co. for $54 billion in cash and stock, the companies announced. The acquisition is the latest move toward consolidation between health insurers and the companies that oversee patients’ drug benefits, and comes as Express Scripts is set to lose its biggest client, Anthem Inc. (Bloomberg)
  • A federal judge who is presiding over hundreds of lawsuits filed by states and local governments against opioid makers and distributors raised the possibility of some cases going to trial amid ongoing disputes between the parties in settlement talks. U.S. District Judge Dan Polster has been pushing for a settlement, but he issued a court filing suggesting a potential “limited litigation track” and possible bellwether trials to resolve some of the cases. (
  • Some Republicans are backing a new legislative push that would move the individual market toward having separate, parallel marketplaces for sick and healthy people. The measure, introduced by Sen. John Barrasso (R-Wyo.), would allow short-term plans to last up to 364 days at a time and have guaranteed renewability. (Axios)
  • New bipartisan legislation would prohibit tribal sovereign immunity from being used to block certain types of patent challenges. The measure, filed by Sen. Tom Cotton (R-Ark.), was introduced approximately six months after Allergan plc transferred patents for its blockbuster drug Restasis to the St. Regis Mohawk tribe in an attempt to keep generic competition from entering the market. (Stat News)

Chart Review

Events Calendar (All Times Local)

AHIP National Health Policy Conference 7:15 a.m.
HHS Secretary Azar speaks at AHIP conference 8:30 a.m.
House Energy and Commerce subcommittee hearing on influenza response 10 a.m.
Senate HELP Committee hearing on opioids 10 a.m.
GWU event on health care systems in the EU 11 a.m.
No events scheduled

Spending on medicines is growing at the slowest rate in years

New report from Prime Therapeutics shows spending on medicines for their commercial plans grew -0.2% in 2017. Spending on medicines in Medicare Part D and Medicaid was even lower, -0.8% and -5.4%, respectively.


Inovalon to buy info tech firm for $1.2 billion, expands client base
Manas Mishra, Reuters

Inovalon Holdings Inc (INOV.O) said on Wednesday it would buy privately held Ability Network for $1.2 billion, as the healthcare data analytics company seeks to reduce its dependence on insurers and add more clients. The company has been expanding its customer-base to include healthcare providers, and the deal could help it add acute care facilities such as hospices, emergency rooms, hospitals and ambulatory centers.

VA chief outlines changes at hospitals nationwide following report on alleged D.C. center mismanagement
Lisa Rein and Emily Wax-Thibodeaux, The Washington Post

Veterans Affairs Secretary David J. Shulkin on Wednesday announced an overhaul of the senior leadership overseeing almost two dozen troubled hospitals across the country following the release of a searing investigation into what the agency watchdog said were management failures that put patients at VA’s flagship medical center in the District at risk. Shulkin said one senior regional official has been reassigned and two others retired as the agency cleans up management of large hospitals and clinics in the Washington area, New England, Phoenix and parts of California.

Controversial study challenges scientific consensus that adult brains make new neurons
Sharon Begley, Stat News

Neuroscientists at the University of California, San Francisco, had a hunch their findings would be controversial, as tends to happen when you challenge popular, world-changing brain research. They were right.

Stocks Climb, Bonds Mixed as Trade War Fears Ease: Markets Wrap
Eddie Van Der Walt, Bloomberg

Risk appetite improved across global markets as investor concern about a potential global trade war appeared to ease. European stocks followed Asian peers higher as core government bonds fell and the dollar strengthened.


New GOP push: bill that would split individual market
Caitlin Owens, Axios

A bill pending on Capitol Hill would move the individual market another step further towards having separate, parallel marketplaces for sick and healthy people. A legislative push – which appears to be backed by some in the White House – would allow short-term plans to both be available for up to a year and to have guaranteed renewability.

Humana’s own charity donation boosts executive bonuses
Bob Herman, Axios

Top Humana executives maxed out their annual cash bonuses in 2017 after the health insurance company used atypical accounting to beef up the measure of profitability that bonuses are based on, according to a new federal filing. This isn’t the first time Humana has doled out bonuses based on juiced-up profit numbers.

Some proposed risk-adjustment changes threaten Medicare Advantage revenue
Shelby Livingston, Modern Healthcare

Health insurer and provider groups railed against the CMS’ proposal to use more patient encounter data to determine Medicare Advantage plans’ risk scores in 2019, saying the data could reduce payments for plans. The CMS proposed moving ahead with the use of encounter data along with several other tweaks to the Medicare Advantage risk-adjustment model in early January.

UnitedHealth tightens reins on emergency department reimbursement
Shelby Livingston, Modern Healthcare

The nation’s largest health insurer, UnitedHealth Group, is following rival Anthem’s footsteps with a new payment policy aimed at reducing its emergency department claims costs. Under the policy, rolled out nationwide March 1, UnitedHealth is reviewing and adjusting facility claims for the most severe and costly ED visits for patients enrolled in the company’s commercial and Medicare Advantage plans.

Dem AGs rip proposed Trump rule on health plans
Nathaniel Weixel, The Hill

A coalition of 17 Democratic state attorneys general is blasting a proposed Trump administration rule to allow health plans to circumvent certain ObamaCare rules. The group, led by New York Attorney General Eric Schneiderman and Massachusetts Attorney General Maura Healey, said the proposal is a thinly veiled attempt to undermine the health-care law.


VA knew for years about dangerous conditions at Washington, D.C., hospital
Donovan Slack, USA Today

Department of Veterans Affairs officials at nearly every level knew for years about sterilization lapses and equipment shortfalls at the Washington, D.C., VA Medical Center, but they were either unwilling or unable to fix the problems, an inspector general’s investigation found. The failures put patients at risk and squandered taxpayer dollars.

Male doctors are disappearing from gynecology. Not everybody is thrilled about it
Soumya Karlamangla, Los Angeles Times

Some patients wait until Dr. Jerome Chelliah snaps on his gloves to make the request. Others blurt it out as soon as he walks in the exam room.

Association health plan rule poses financial threat for providers
Virgil Dickson, Modern Healthcare

Several hospitals and clinician groups have warned the federal government that uncompensated care costs could soar if the Department of Labor finalizes a rule that would allow more small businesses and self-employed workers to band together to buy insurance via association health plans. The proposed rule, which grew out of an executive order issued in October, would broaden the definition of an employer under the Employee Retirement Income Security Act of 1974, or ERISA, to allow more groups to form association health plans and bypass ACA rules.

Pharma, Biotech and Devices

Cigna Agrees to Buy Express Scripts in $67 Billion Deal
Peter Vercoe, Bloomberg

Cigna Corp. agreed to buy Express Scripts Holding Co. for $54 billion in cash and stock, another move toward consolidation between U.S. health insurers and the companies that oversee patients’ drug benefits. The price includes $48.75 in cash and 0.2434 shares of stock of the combined company per Express Scripts share, the companies said in a statement Thursday.

Judge trying to settle opioid lawsuits says trials may be possible to overcome hurdles in talks
Eric Heisig,

A federal judge in Cleveland pushing for a settlement in hundreds of lawsuits filed by local and state governments against drug manufacturers and distributors over the nation’s opioid crisis has raised the possibility of some of the cases going to trial. The revelation came a day after attorneys convened in Cleveland for another round of settlement talks, and was put in a court filing U.S. District Judge Dan Polster issued Wednesday.

Lawmakers file a bill to block maneuvers like Allergan’s patent deal with Mohawks
Ed Silverman, Stat News

Angered by a controversial Allergan (AGN) patent maneuver, a handful of lawmakers introduced a bill that would prohibit tribal sovereign immunity from being used to block certain types of patent challenges. The move comes six months after Allergan transferred six patents for its best-selling Restasis eye treatment to the St. Regis Mohawk tribe, which has sovereign immunity and has attempted to use its status to block patent challenges filed by several generic drug makers.

Of ‘Miracles’ And Money: Why Hemophilia Drugs Are So Expensive
Jenny Gold, Kaiser Health News

When Landon Morris was diagnosed with hemophilia shortly after birth, his mother, Jessica Morris, was devastated. “It was like having your dreams — all the dreams you imagined for your child — just kind of disappear,” she recalled.

Health IT

Rucker: Interoperability depends on open APIs
Rachel Z. Arndt, Modern Healthcare

To advance interoperability, healthcare organizations must turn to open application programming interfaces, federal healthcare IT chief Dr. Don Rucker said Tuesday. Speaking in a “fireside chat” at the annual conference of the Healthcare Information and Management Systems Society, Rucker drew on the call for interoperability at the heart of Jared Kushner’s and CMS Administrator Seema Verma’s speeches Tuesday morning.

Heart monitor links patients to doctors using the one thing they’re unlikely to forget—their phones
Angelica LaVito, CNBC

Mason Rinks would be studying for exams or working at his internship when he would feel lightheaded and dizzy and sometimes experience palpitations. Away at school and out of his insurance network, he wouldn’t know what to do.

SF tech startup Atomwise gets $45M for AI-powered drug design software
Brittany Meiling, Endpoints News

A Silicon Valley software company that’s using artificial intelligence to take the guess work out of structure-based drug design is trotting out a sizable Series A round this morning. The deal includes investors that run the gamut, from tech to biopharma to agrochemicals.

A Message from PhRMA: 

Patients share the costs. They should share the savings.

While spending on medicines is growing at the slowest rate in years, unfortunately it doesn’t feel that way for patients. More than one-third of a medicine’s list price is often rebated back to middlemen, like insurers and pharmacy benefit managers (PBMs).

These discounts and rebates create savings of more than $100 billion, but insurers don’t always share these savings with patients.

Opinions, Editorials and Perspectives

Narrow Networks Are Bad for Patients and Unlikely to Save Money
George Hruza, Morning Consult 

As a dermatologic surgeon, I treat many elderly patients who have skin cancers. These patients usually have Medicare Advantage plans designed to help them obtain quality health coverage for a variety of conditions.

Proposed Reforms To The 340B Drug Discount Program
Rena M. Conti et al., Health Affairs

The original goal of the 340B drug discount program was to allow qualified providers to “stretch federal resources as far as possible reaching more eligible patients and providing more comprehensive services.” In recent years, the program has come under scrutiny as the number of participating disproportionate share hospitals (DSHs) and their “child” affiliates have undergone tremendous growth.

The President’s Budget Proposal Would Hurt Medicare Beneficiaries In The Part D “Donut Hole”
Aditi P. Sen et al., Health Affairs

President Donald Trump’s proposed budget includes several provisions intended to modernize the Medicare Part D drug benefit. One of these proposals is to exclude the amount discounted by manufacturers from the calculation of beneficiary out-of-pocket spending in the Medicare Part D coverage gap.

Research Reports

The ACA’s LGBTQ Nondiscrimination Regulations Prove Crucial
Sharita Gruberg and Frank J. Bewkes, The Center for American Progress

After six years and nearly 25,000 public comments, the U.S. Department of Health and Human Services (HHS) issued a rule in May 2016 to implement Section 1557 of the Affordable Care Act (ACA), clarifying that discrimination based on sex stereotyping and gender identity is impermissible sex discrimination under the law. This position was in line with growing case law to support prohibitions against sex discrimination covering LGBTQ people.

Bailouts Will Not Bring Lasting Stability to the Health Insurance Market
Nina Owcharenko Schaefer, The Heritage Foundation

Congress reportedly is contemplating appropriating more federal funding to prop up the Affordable Care Act (ACA, also known as Obamacare) and its harmful policy regulations. The radical and unnecessary changes in insurance regulations made by the ACA created much bigger problems in the insurance market that upended existing federal and state regulation of health insurance, destabilized the individual health insurance market, and resulted in higher costs and fewer choices.