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Trends that Matter for Managed Care Coverage

Posted by Matt Breese on Jun 11, 2016

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A collection of engaging infographics from healthcare influencers to capture trends in managed care coverage and managed health services.

The increasing percentage of provider-led Medicare managed care plans and managed care organizations demonstrates the value of deeper payer and provider integration. These plans account for one-fifth of Medicare Advantage plans, with many earning 5 star ratings by CMS. View the full infographic via Oliver Wyman.

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Over the past decade, Medicare's share of overall prescription drug spending increased from a negligible 2% to around 30%, via JAMA.

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Research points to the enormous Medicare spending each year. With CMS allocating $800+ per member to pay benefits and 20% of Medicare beneficiaries consuming 80% of the spending budget, some experts question how long the current system will stay afloat, according to MostMedicare.

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In the federal marketplace, differentiating combined deductibles and separate deductibles is critical. Specialty prescriptions show the largest difference, with only 35% of combined deductible and 60% of separate deductible plans covering the cost of a prescription before the deductible is met. Analysis via April L.J. Seifert, Ph.D.

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An analysis of the Hepatitis C treatment landscape reveals the variance in drug coverage across various channels. Nearly half of Medicare formularies do not cover Hep C treatments while half of health exchange formularies restrict access with prior authorizations or step therapies. View the full reality check to learn more about managed care coverage in Hepatitis C.

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Follow us on Twitter @MMITnetwork to stay current with new updates on trends affecting the pharma, payer and the provider network.

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Topics: Industry Trends, Market Access, Payer