Payer Roundup–Liviniti, Noom enter partnership; Michigan plans must cover cancer therapies

Below is a round-up of payer-centric news for the week of Jan. 8., 2024

UPDATED: Tuesday, Jan. 9 at 3:00 ET

Liviniti and Noom enter partnership

Louisiana-based pharmacy benefit manager Liviniti, a member of the new Transparency-Rx coalition that distances itself from other heavyweights in its industry, is partnering with weight management company Noom.

The collaboration, beginning in March, onboards patients and assists individuals with nutrition, exercise and psychology-based behavioral change throughout a patient's journey. Noom Chief of Medicine Linda Anegawa, M.D., said in a press release that the program offers a holistic treatment plan for those who use GLP-1 medications.

“We are proud to partner with Noom to offer Liviniti clients flexible weight management solutions,” said Liviniti CEO LeAnn Boyd in a statement. “We understand each employer is unique and may have different philosophies regarding coverage for this exciting, yet costly class of medications. Known for our flexibility, our programs include a range of proven options that can be implemented alongside current plan design for weight loss.” - Noah Tong

UPDATED: Tuesday, Jan. 9 at 2:00 ET

Michigan regulator cracks down on health insurers

Michigan Department of Insurance and Financial Services (DIFS) Director Anita Fox sternly reminded health insurers Tuesday they must cover cancer therapies such as CAR-T if certain conditions are met. These treatments are potentially life-saving but some patients have faced difficulty receiving care, sparking backlash.

Patients can file complaints about their health insurer by contacting DIFS if they are denied a health insurance claim. If the agency rules in favor of the patient, an insurer could face penalties.

The news was first reported by ProPublica. - Noah Tong

Self-funded employer-sponsored insurance plans increased 5% from 2015-2021: study

A new report in Health Affairs revealed that self-funded employer-sponsored health plans grew from 55% to 60% from 2015 to 2021, equating to a 2.8 million member increase in enrollment.

It found that 44 states experienced an increase of self-funded plans in this time period. Places that saw the most growth were northern California, New York, Arkansas, Pennsylvania and Utah.

Elevance Health was deemed the largest insurer in the self-funded market, representing 19% of the total market of members in self-funded plans, while CVS Health enrollment grew the fastest among its competitors.

This study received grant support from Arnold Ventures. - Noah Tong