Pharmaceutical Industry Roundup: Acquisitions, Policy Changes, and Drug Pricing Trends

SCAN Group Acquires PACE Organization, Strengthening Elderly Care Services

SCAN Group has become the sole owner of myPlace Health, a company operating under the Program for All-Inclusive Care for the Elderly (PACE) model. Previously co-owned with Commonwealth Care Alliance, this acquisition allows SCAN Group to expand its impact on delivering comprehensive care to older adults with complex healthcare needs.

Dr. Sachin Jain, president and CEO of SCAN Group, emphasized the effectiveness of the PACE model, stating, "By fully bringing myPlace Health into SCAN's family of companies, we're asserting our belief that PACE is one of the most effective models for delivering holistic, comprehensive care to older adults with the most complex healthcare needs."

Medicaid Changes and Their Potential Impact

As Congress debates a reconciliation bill with significant Medicaid changes, several studies have highlighted the program's importance and the potential consequences of cuts:

• Medicaid expansion under the Affordable Care Act reduced mortality by 2.5% in the low-income adult population, or 21% among new enrollees.
• A 15% cut in Medicaid could result in $1.8 billion in lost revenue for rural hospitals, equivalent to the salaries of 21,000 full-time employees.
• The Urban Institute projects that proposed changes could lead to 15.9 million more uninsured individuals by 2034, potentially reducing provider revenues by over $1 trillion between 2025 and 2034.

Cancer Drug Pricing and Medicare Part D Changes

A JAMA Network study revealed that the launch prices of anticancer therapy drugs have increased by an average of $1,700 per year, with prices up to 200% higher than if only affected by inflation. The study suggests that pharmaceutical companies are continuing to maximize prices for anticancer therapies, even after the implementation of the Inflation Reduction Act (IRA).

In related news, nearly 3 million people lost their Medicare Part D insurance coverage in 2024, with 7.5% of beneficiaries losing their Part D insurer. This significant increase in coverage loss may be attributed to changes in the Part D prescription benefit and the introduction of a $2,000 out-of-pocket spending limit under the IRA.

State-Level Healthcare Initiatives and Industry Developments

Several states have introduced new healthcare legislation and programs:

• Virginia is considering mandating coverage for in vitro fertilization as an essential health benefit.
• Georgia and Indiana have passed laws aimed at improving pharmacy reimbursement and regulating pharmacy benefit managers.
• Colorado is studying the implementation of a single-payer system and has mandated coverage for gender-affirming care.

In the private sector, CareSource has acquired Lakeland Care, a Wisconsin-based managed care provider, marking its third agreement with a Wisconsin health organization. This move comes as the demand for long-term care is expected to nearly double in the next five years.