Trends in Common Ownership among Insurers in Medicare Part D.

BACKGROUND: Recent studies document the rising prevalence of common ownership by institutional investors in specific industries. Those investors offer products, such as mutual and index funds, to trade securities on behalf of others and often own shares of multiple firms in the same industry to diversify portfolios. However, at present, few studies focus on common ownership trends in health care. OBJECTIVES: This paper examines institutional investors' common ownership in the major insurers offering plans in the Medicare Part D stand-alone prescription drug plan (PDP) market between 2013 and 2020. RESEARCH DESIGN: Using data from the Securities and Exchange Commission (SEC) database and the Center for Research in Securities Prices, we compute the percentages of outstanding shares of each insurer owned by institutional investors. Data visualization and network analysis are employed to assess the trends in common ownership among major insurers. RESULTS: We document a high prevalence of and substantial increase in shared institutional investors in the PDP market. From 2013 to 2020, the degree of common ownership increased by 7% on average, and the common ownership network became more connected. Common ownership also varies across the 34 PDP regions depending on their reliance on listed insurers, that are traded in the stock exchange, offering stand-alone PDPs. CONCLUSIONS: High and rising common ownership in the Medicare Part D PDP market raises policy questions about potential effects on plan offerings, premiums, and quality for consumers.

(NHC)Ni(II)-Directed Insertions and Higher Substituted Olefin Synthesis from Simple Olefins.

ConspectusWell-controlled olefin insertion is critical for achieving catalytic and productive bulk and fine-chemical synthesis. Developing efficient and selective methods for meeting diverse insertion demands is extremely noteworthy, as it supports numerous transformations. The challenges are related to improving catalyst performance and selectivity control and uniting previously unreactive substrate pairs to achieve higher molecular structural complexity and utility. Nickel catalysts have received persistent attention in higher substituted olefin synthesis and polymerization, and numerous new strategies have been established to fulfill the ever-changing demands. This Account focuses on the recent progress based on N-heterocyclic carbene (NHC) ligands and nickel catalysts in our laboratory in using simple terminal olefins as olefin donors or acceptors.It begins with a brief history of olefin codimerization and the major advances in hydrovinylation achieved by other research groups using ethylene as an olefin donor. It then describes problems related to the reductive elimination that can occur when both the hydrometalated alkene and NHC are on the catalyst. It emphasizes the impact of NHC catalyst generation methods on the competing reactivity. Next, it explains the principal challenges and great opportunities in using our method (with α-olefins as olefin donors and alkenyl sources) to replace intermolecular reductive hydroalkenylation reactions (which require rare and more expensive alkenyl halides and boronic acids as reactants, alongside a stoichiometric amount of metallic reagents). The Account then illustrates the potential uses of our method for solving challenging organic synthesis problems using tailor-made (NHC)Ni(II) catalysts to allow redox-neutral catalytic cycles based on high chemo- and regioselective cross-insertion controls. It shows that upon optimal steric and electronic cooperation between the NHC, olefin donor, and olefin acceptor, regiodivergent insertion and convergent synthesis can be achieved easily.In the course of our work, we uncovered several unique insights into regulating (anti-)Markovnikov hydronickelation, carbonickelation, hydrocarbonation, ring closure, 1,3-allyl shift, isomerization, and catalyst regeneration under green, neutral, and mild-temperature conditions. These insights are also outlined here, along with theoretical calculations that offer additional understandings of the insertion reactivity and selectivity differences observed between the NHC and the highly related phosphorus-based Ni(II) hydride-catalyzed cross-hydroalkenylation and cycloisomerization systems.Compared to traditional olefin and cyclic structure synthesis technology, such as olefin cross-metathesis, enyne cyclization, and cross-coupling reactions, the new catalyst systems often offer previously inaccessible product structural characteristics, substrate scope, and outcomes. In particular, the method is effective for the catalytic synthesis of unsymmetrical and functionalized 1,1-disubstituted olefins (a.k.a. gem-olefins), 1,4-dienes (a.k.a. skipped dienes), conjugated dienes, endo- and exocyclic olefins, fused and spiro rings, and aromatic products. These syntheses are variously achieved by cross-hydroalkenylation, insertion-induced rearrangement, cycloadditions, and other approaches inspired by our investigations and detailed in this Account. Cross-hydroalkenylation can be achieved with high enantioselectivity by application of carefully designed and structurally flexible C1 and C2 chiral NHC ligands, yielding a pool of chiral branched alkenes and 1,4-dienes directly from simple chemical feedstocks used in industry. This Account will draw further attention to green alkenylation and the related development of redox-neutral catalytic cycles.

(NHC)Pd(II) hydride-catalyzed dehydroaromatization by olefin chain-walking isomerization and transfer-dehydrogenation.

Transition-metal-catalyzed homogeneous dehydrogenation and isomerization are common organic molecular activation reactions. Palladium hydrides are good olefin isomerization catalysts but are usually short-lived species under redox-active dehydrogenation conditions. Here, we show that Pd-H in the presence of an N-heterocyclic carbene ligand and an alkene regulator enables transfer-dehydroaromatization, avoiding the homo-disproportionation pathway. The desired product is obtained with up to 99:1 selectivity, and the exo-to-endo olefin isomerization can be carried out in one pot. In contrast to previously reported methods that rely on the efficient removal of Pd-H, the approach reported herein benefits from the steric effects of the N-heterocyclic carbene and the choice of alkene to regulate the competing reactivity of allylic C‒H activation and hydropalladation. This method circumvents the challenges associated with tedious olefin separation and a low exo-to-endo olefin isomerization ratio and expands the scope to include challenging endo- and exo-cyclic olefins under mild, neutral, and oxidant-free conditions. Overall, herein, we provide a strategy to synthesize (hetero)aromatic compounds via chemoselective dehydrogenation of cyclic alkenes over ketones and the dehydrogenative Diels-Alder reaction of a cyclic enamine.

NHC-Ni(II)-catalyzed cyclopropene-isocyanide [5 + 1] benzannulation.

Isocyanides are common compounds in fine and bulk chemical syntheses. However, the direct addition of isocyanide to simple unactivated cyclopropene via transition metal catalysis is challenging. Most of the current approaches focus on 1,1-insertion of isocyanide to M-R or nucleophilc insertion. That is often complicated by the competitive homo-oligomerization reactivity occurring at room temperature, such as isocyanide 1,1-insertion by Ni(II). Here we show a (N-heterocyclic carbene)Ni(II) catalyst that enables cyclopropene-isocyanide [5 + 1] benzannulation. As shown in the broad substrate scope and a [trans-(N-heterocyclic carbene)Ni(isocyanide)Br2] crystal structure, the desired cross-reactivity is cooperatively controlled by the high reactivity of the cyclopropene, the sterically bulky N-heterocyclic carbene, and the strong coordination ability of the isocyanide. This direct addition strategy offers aromatic amine derivatives and complements the Dötz benzannulation and Semmelhack/Wulff 1,4-hydroquinone synthesis. Several sterically bulky, fused, and multi-substituted anilines and unsymmetric functionalized spiro-ring structures are prepared from those easily accessible starting materials expediently.

NHC-Ni catalyzed enantioselective synthesis of 1,4-dienes by cross-hydroalkenylation of cyclic 1,3-dienes and heterosubstituted terminal olefins.

Enantioenriched 1,4-dienes are versatile building blocks in asymmetric synthesis, therefore their efficient synthesis directly from chemical feedstock is highly sought after. Here, we show an enantioselective cross-hydroalkenylation of cyclic 1,3-diene and hetero-substituted terminal olefin by using a chiral [NHC-Ni(allyl)]BArF catalyst. Using a structurally flexible chiral C2 NHC-Ni design is key to access a broad scope of chiral 1,4-diene 3 or 3' with high enantioselectivity. This study also offers insights on how to regulate chiral C2 NHC-Ni(II) 1,3-allylic shift on cyclic diene 1 and to build sterically more hindered endocyclic chiral allylic structures on demand.

NHC/Nickel(II)-Catalyzed [3+2] Cross-Dimerization of Unactivated Olefins and Methylenecyclopropanes.

Cross-dimerization of a methylenecyclopropane (1) and an unactivated alkene (2) with typical hydroalkenylation reactivity was observed for the first time by using a [NHC-Ni(allyl)]BArF catalyst (NHC=N-heterocyclic carbene). Results show that the C-C cleavage of 1 did not involve a Ni0 oxidative addition, which was crucial in former systems. Thus the method reported here emerges as a complementary method for attaining highly chemo- and regioselective synthesis of methylenecyclopentanes (3) with broad scope. An efficient NHC/NiII -catalyzed rearrangement of 1 leads to the convergent synthesis of 3 in the presence of 2.

NHC-Ni catalyzed 1,3- and 1,4-diastereodivergent heterocycle synthesis from hetero-substituted enyne.

Diastereodivergent heterocycle synthesis has been recognized as an important tool for drug discovery in recent years, yet strategies based on nickelacycle formation have not been established. Here, we report a NHC-Ni catalyzed highly 1,3- and 1,4-diastereodivergent heterocycle synthesis from enyne, which is achieved by manipulating the enyne N-substituent (allowing switching of selectivity from up to 2:98 to 98:2). The key to success is the efficient diastereodivergent formation of a nickelacyclopentene, with broad enyne scope at mild conditions, which subsequently provides reductive hydroalkenylation, acylation and silylation products on demand. Diastereoisomers which are sterically hard to distinguish or difficult to access by conventional routes are now accessible easily, including those with very similar 4°, contiguous and skipped stereocenters.

Synthesis and study of Au(iii)-indolizine derivatives: turn-on luminescence by photo-induced controlled release.

The photo- and structural properties of a series of Au(iii) indolizine complexes were determined. Controlled release of halogenated indolizine derivatives from the corresponding Au(iii) complexes was achieved by photoinduced C-X bond formation, which provided turn-on luminescence with an increase in emission intensity of up to 67 times.

[(NHC)NiII H]-Catalyzed Cross-Hydroalkenylation of Cyclopropenes with Alkynes: Cyclopentadiene Synthesis by [(NHC)NiII ]-Assisted C-C Rearrangement.

A cross-hydroalkenylation/rearrangement cascade (HARC), using a cyclopropene and alkyne as substrate pairs, was achieved for the first time by using new [(NHC)Ni(allyl)]BArF catalysts (NHC=N-heterocyclic carbenes). By controlling the (NHC)NiII H relative insertion reactivity with cyclopropene and alkyne, a broad scope of cyclopentadienes was obtained with highly selectively. The structural features of the new (NHC)NiII catalyst were important for the success of the reaction. The mild reaction conditions employed may serve as an entry for exploring (NHC)NiII -assisted vinylcyclopropane rearrangement reactivity.

Intranasal delivery of a novel acetylcholinesterase inhibitor HLS-3 for treatment of Alzheimer's disease.

AIM: The present study aims to investigate the pharmacokinetics and pharmacodynamics of HLS-3, a tacrine dimer with high anti-acetylcholinesterase activity for the treatment of Alzheimer's disease. MAIN METHODS: In vitro Calu-3 and Caco-2 cell monolayer transport and liver microsomal incubation studies of HLS-3 were carried out to evaluate its nasal epithelium and intestinal membrane permeability, transporters involved in absorption and hepatic metabolism. In vivo pharmacokinetics of HLS-3 followed by central and peripheral cholinergic mediated responses and ex vivo AChE activities in rats via oral and intranasal administrations were further investigated and compared. KEY FINDINGS: Our in vitro studies suggested that HLS-3 is the substrate of both P-gp and MRPs with no significant hepatic oxidation and glucuronidation metabolism. Oral administration only delivered trace amount of HLS-3 in systemic circulation with a high faecal recovery of 70.7%, whereas intranasal administration demonstrated an absolute bioavailability of 28.9% with urinary and faecal recoveries of 1.5% and 34.0%, respectively. In comparison to oral administration of HLS-3, intranasally delivered HLS-3 exhibited significant higher central cholinergic mediated responses without obvious peripheral side effect. SIGNIFICANCE: Intranasal delivery of HLS-3 with better pharmacokinetics and pharmacodynamics performances provides a promising approach for treatment of Alzheimer's disease.

(NHC)NiH-Catalyzed Regiodivergent Cross-Hydroalkenylation of Vinyl Ethers with α-Olefins: Syntheses of 1,2- and 1,3-Disubstituted Allyl Ethers.

Cross-hydroalkenylation of a vinyl ether (1) with an α-olefin (2) was first achieved by a set of [NHC-Ni(allyl)]BArF (NHC=N-heterocyclic carbene) catalysts. Both 1,2- and 1,3-disubstituted allyl ethers were obtained, highly selectively, by using NHCs of different sizes. In contrast, the chemoselectivity (i.e., 1 as acceptor and 2 as donor) was controlled mostly by electronic effects through the catalyst-substrate interaction. Sterically bulkier alkenes (2) were used as preferred donors compared to smaller alkenes. This electronic effect also served as a basis for the first tail-to-head cross-hydroalkenylations of 1 with either a vinyl silane or boronic ester.

The mechanism and regioselectivities of (NHC)nickel(ii)hydride-catalyzed cycloisomerization of dienes: a computational study.

Transition metal-catalyzed hydroalkenylation is widely applied in organic synthesis to construct carbon-carbon bonds and synthesize substituted alkenes. In this work, the mechanism and regioselectivities of [(NHC)NiH]+-catalyzed intramolecular cycloisomerization of dienes are studied by density functional theory (DFT) calculations. Through an initial hydride insertion, [(NHC)NiH]+ reacts with the diene substrate to generate the alkyl nickel species. This alkyl nickel species is the resting state of the catalytic cycle, and the hydroalkenylation reaction involves sequential olefin insertion and ß-hydride transfer. The selectivity between the possible cycloisomerization products is determined by both the olefin insertion and ß-hydride transfer steps. The olefin insertion favors the exo-cyclization due to the high ring strain of the insertion transition states for the endo-cyclization. In the ß-hydride transfer step, the hydride transfers to the internal olefin position selectively to avoid the steric repulsions between the bulky NHC ligand and the alkyl substituent of the olefin substrate. This selectivity of ß-hydride transfer leads to the n-exo cyclization instead of the (n - 1)-exo cyclization. These mechanistic insights will shed light on the future development of transition metal-catalyzed hydroalkenylation reactions.

(NHC)NiH-Catalyzed Intermolecular Regio- and Diastereoselective Cross-Hydroalkenylation of Endocyclic Dienes with α-Olefins.

Highly selective cross-hydroalkenylations of endocyclic 1,3-dienes at the least substituted site with α-olefins were achieved with a set of neutral (NHC)NiII H(OTf) catalysts and cationic NiII catalysts with a novel NHC ligand. Under heteroatom assistance, skipped dienes were obtained in good yields, often from equal amounts of the two substrates and at a catalyst loading of 2-5 mol %. Rare 4,3-product selectivity (i.e., with the H atom at C4 and the alkenyl group at C3 of the diene) was observed, which is different from the selectivity of known dimerizations of α-olefins with both acyclic Co and Fe systems. The influence of the various substituents on the NHC, 1,3-diene, and α-olefin on the chemo-, regio-, and diastereoselectivity was studied. High levels of chirality transfer were observed with chiral cyclohexadiene derivatives.

Catalytic asymmetric hydroalkenylation of vinylarenes: electronic effects of substrates and chiral N-heterocyclic carbene ligands.

An asymmetric tail-to-tail cross-hydroalkenylation of vinylarenes with terminal olefins was achieved by catalysis with NiH complexes bearing chiral N-heterocyclic carbenes (NHCs). The reaction provides branched gem-disubstituted olefins with high enantioselectivity (up to 94 % ee) and chemoselectivity (cross/homo product ratio: up to 99:1). Electronic effects of the substituents on the vinylarenes and on the N-aryl groups of the NHC ligands, but not a π,π-stacking mechanism, assist the steric effect and influence the outcome of the cross-hydroalkenylation.

Synthesis, biological activity, and biopharmaceutical characterization of tacrine dimers as acetylcholinesterase inhibitors.

Tacrine (THA), as the first approved acetylcholinesterase (AChE) inhibitors for the treatment of Alzheimer's disease (AD), has been extensively investigated in last seven decades. After dimerization of THA via a 7-carbon alkyl spacer, bis(7)-tacrine (B7T) showed much potent anti-AChE activity than THA. We here report synthesis, biological evaluation and biopharmaceutical characterization of six THA dimers referable to B7T. According to IC50 values, the in vitro anti-AChE activities of THA dimers were up to 300-fold more potent and 200-fold more selective than that of THA. In addition, the anti-AChE activities of THA dimers were found to be associated with the type and length of the linkage. All studied THA dimers showed much lower cytotoxicity than B7T, but like B7T, they demonstrated much lower absorptive permeabilities than that of THA on Caco-2 monolayer model. In addition, all THA dimers demonstrated significant efflux transport (efflux ratio >4), indicating that the limited permeability could be associated with the efflux transport during absorption process. Moreover, the dimer with higher Log P value was accompanied with higher permeability but lower aqueous solubility. A balanced consideration of activity, solubility, cytotoxicity and permeability should be conducted in selection of the potential candidates for further in vivo investigation.

Medium-sized heterocycle synthesis by the use of synergistic effects of Ni-NHC and γ-coordination in cycloisomerization.

This paper describes a new approach in transition-metal-catalyzed unsymmetric cycloisomerization for medium-sized heterocycles. The steric and electronic effects of an NHC-NiH catalyst and γ-heteroatom chelation were used together as a basis for 1,n-diene termini differentiation and for n(γ)-exo-trig (head-to-tail) product selectivity. Heterocycles bearing an exocyclic methylene such as oxepines, thiepines, siloxepines, and oxocanes were synthesized from the corresponding 1,n-dienes by a fine-tuning of the NHC properties. The implication of the underlying hypothesis was further demonstrated in a competition experiment in which strained oxepines were formed preferentially over other competing oxa-/carbocycles. Under more forcing physical conditions and the use of a suitable NHC ligand, the exocyclic methylene products were isomerized further into endocyclic olefin products regioselectively in one pot.

Shuffle off the classic ß-Si elimination by Ni-NHC cooperation: implication for C-C forming reactions involving Ni-alkyl-ß-silanes.

Via a cooperation of NHC, Si substituents and a M center, ß-Si elimination was attenuated, revealing a new way to attain a high Ni-ß-SiR(3):Ni-σ-SiR(3) ratio. The scope is illustrated by a head-to-tail vinylsilane-α-olefin hydroalkenylation.

Nitrile assisted, Brønsted acid catalyzed regio and stereoselective diarylphosphonylation of allyl silyl ethers.

We have discovered a mild, catalytic protocol for the regio- and stereoselective synthesis of trisubstituted allyl diarylphosphonates from the corresponding disubstituted allyl silyl ethers, circumventing the challenges related to the preparation and availability of stereodefined trisubstituted olefins. A closely related arylation reaction was also discovered during the methodology development. By simply switching the reaction medium, high phosphonylation/arylation ratios and vice versa can be achieved. This may not be a direct result of changing solvent polarity. The allyl diarylphosphonates were evaluated as carboxylesterase inhibitors, and the screening results revealed that the inhibitory efficiency is highly related to the choice of alkenes and aryl substituents.

Cyanative alkene-aldehyde coupling: Ni(0)-NHC-Et2AlCN mediated chromanol synthesis with high cis-selectivity at room temperature.

Described are several classes of Ni(0) mediated cyanative alkene-aldehyde coupling reactions, providing 6-membered cores, which complement existing cyclization technology in several respects. Et(2)AlCN was used as both a cyclization accelerator and CN source. The NHC ligand may have a positive effect in differentiating reductive elimination and syn-beta-hydride elimination.