SCAN Health Plan, a nonprofit health insurer specializing in Medicare Advantage (MA) offerings, is choosing to move faster than the government’s drug price negotiation timetable and is also offering further niche plan options for its various customer segments.
Select SCAN MA plans will have access to 13 name-brand drugs, six of which are on President Joe Biden’s negotiation list, for either $0 or $11 per month starting in 2024. The list comprises Eliquis, Xarelto, Jardiance, Januvia, Farxiga, Entresto, Tradjenta, Janumet, Synjardy, Xigduo, Trijardy, Glyxambi and Jentadueto and was first reported by Axios.
The nonprofit is choosing to lower costs for seniors two years earlier than the Centers for Medicare & Medicaid Services' drug price negotiation program would go into effect. Even if the courts decide to strike down the program, SCAN Chief Pharmacy Officer Sharon Jhawar said their insurance plan will stay take effect, as promised, because they believe it offers great value to its customers compared to other plans from competitors.
“I think what you see in Medicare Advantage is everything in the kitchen sink,” she said to Fierce Healthcare. “You can see pet walking and OTC benefits to buy $300 worth of cotton balls and things like that. And we were just asking ourselves, ‘Does that really improve your health?’”
SCAN said some plans will allow customers to pay a $0 copay for certain diabetes and cardiovascular drugs, while members in other offerings will pay up to $11. Customers will not be subject to prior authorizations.
By encouraging beneficiaries to take prescription drugs, the MA insurer will end up lowering costs long-term, since those prescriptions can prevent hospitalizations that would be more burdensome, Jhawar said.
In addition, the insurer is launching SCAN Inspired, one of the first MA plans geared entirely toward women. Members will receive $0 estrogen therapy, an enhanced OTC catalog for women’s health, high-end fitness facilities and boutique studios, a weight management program reimbursement and health and wellness events.
“A lot of health plans cover Viagra for no co-pay, but really don’t have anything specific for women,” Jhawar explained, noting that women also want to stay active in activities such as Pilates as they enter into Medicare and the later years of their lives.
ApolloMed formed a 10-year value-based care partnership with SCAN Health, the organizations told MedCity News Sunday. It will create a health plan called Compass, which is a provider-specific plan through SCAN. Approximately 70% of ApolloMed’s patients are Asian, Hispanic or African American.
Last October, SCAN spearheaded SCAN Affirm, a plan for LGBTQ+ seniors in partnership with Included Health. It includes a care concierge and navigation platform to improve health literacy. Its membership has grown to 1,000 members and will expand from Los Angeles and Riverside counties to San Diego, Orange and San Francisco counties, effective Jan. 1.
Special needs plans from SCAN will expand to other locations starting in 2024 as well.
“What we're finding is people want to join offerings that really identify and provide them a dignified health journey and providing a care delivery journey with affirming providers and the medications that matter to them,” she said.
SCAN currently offers products in California, Arizona, Nevada, Texas and New Mexico. Its Inspire plan will only be available in Orange County and Los Angeles County, in partnership with Cedars-Sinai, for now.