Contact

Payer

Pharma

Provider

Formulary guidance and transparency from P&T to point of care

Jane Anderson

Recent Posts

Radar On Market Access: Despite New Approvals, Plans Still Favor Generics for Epilepsy

Posted by Jane Anderson on Jan 5, 2021

Pharmaceutical treatment for different types of epilepsy generally still relies on tried-and-true generics, despite recent efforts by drug manufacturers to introduce new branded medications into the mix, PBM insiders tell AIS Health.

Xcopri (cenobamate tablets), manufactured by SK Biopharmaceuticals Co., Ltd.'s subsidiary SK Life Science, Inc., launched in May for the treatment of partial-onset seizures. However, many plans haven't jumped to add Xcopri to their formularies, says Mesfin Tegenu, R.Ph., president of PerformRx.

Read More

Topics: Industry Trends, Market Access, Product Release

Radar On Market Access: Teledermatology Program Reduces Patient Wait Time But Doesn't Increase Utilization

Posted by Jane Anderson on Nov 26, 2020

A pilot telemedicine program dramatically reduced the amount of time it took for primary care physicians to consult with dermatologists on skin ailments but did not increase utilization or cost, according to a new study from Independence Blue Cross and the University of Pennsylvania, AIS Health reported.

"Dermatology is an ideal specialty for telemedicine due to the visual nature of the clinical assessment," says study co-author Aaron Smith-McLallen, director of health informatics and advanced analytics at Independence Blue Cross. "Using telemedicine, patients can get quality care very quickly and reduce wait times for patients with more acute needs that are not suitable for telemedicine intervention."

Read More

Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Insurer-Affiliated PBMs Propel Parent Firms' Revenues in Third Quarter

Posted by Jane Anderson on Nov 19, 2020

Large insurer-affiliated PBMs saw strong results for the third quarter of 2020, in several cases driving revenues for parent companies that are grappling with various disruptive effects of the coronavirus pandemic, AIS Health reported.

At CVS Health Corp., which reported earnings on Nov. 6, total revenues increased 3.5% year over year to $67 billion, and the company posted earnings per share (EPS) of $1.66, beating analysts' estimates.

Read More

Topics: Industry Trends, Data & Analytics

Radar On Market Access: CVS, OptumRx Exclude Brand-Name Inhalers From 2021 Formularies, Switch Up Diabetes Supplies

Posted by Jane Anderson on Oct 13, 2020

CVS Health Corp.'s Caremark will exclude 57 medications from its 2021 formulary and add six back. Meanwhile, UnitedHealth Group’s OptumRx subsidiary will exclude 19 medications and products while adding back five and implementing restrictions on others, AIS Health reported.

Still, only a handful of products excluded by either PBM are likely to impact many members adversely, says Marc Guieb, a pharmacist and consultant with Milliman Inc. That also applies to the exclusions announced earlier by Cigna Corp.-owned PBM Express Scripts, he adds.

Read More

Topics: Industry Trends, Market Access, Data & Analytics, Payer

Radar On Market Access: Payers Face Challenges to Enroll Newly Uninsured

Posted by Jane Anderson on Aug 27, 2020

Health insurers are conducting outreach to people who may have been left without coverage as a result of the COVID-19 crisis, but experts say they may be partially stymied in their efforts to get people enrolled in new plans by the difficulties of operating within a pandemic environment, AIS Health reported.

AmeriHealth Caritas, which is run by Independence Blue Cross in partnership with Blue Cross Blue Shield of Michigan, says it has launched a series of videos designed to help potential Medicaid enrollees learn how they can apply.

Read More

Topics: Industry Trends, Data & Analytics, Payer

Perspectives on UnitedHealth, Humana's Chronic Conditions Programs

Posted by Jane Anderson on Aug 20, 2020

Both UnitedHealthcare and Humana Inc. are rolling out new disease-specific care management programs aimed at providing patients with the tools they need to help control their chronic conditions, AIS Health reported.

The new initiatives highlight new digital and time-tested interpersonal ways of managing chronic conditions, observers say.
 
Read More

Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: UnitedHealth, Humana Launch Programs for Chronic Conditions

Posted by Jane Anderson on Jul 30, 2020

Both UnitedHealthcare and Humana Inc. are rolling out new disease-specific care management programs aimed at providing patients with the tools they need to help control their chronic conditions, AIS Health reported.

The new initiatives highlight new digital and time-tested interpersonal ways of managing chronic conditions, observers say.

Read More

Topics: Data & Analytics, Payer

Perspectives on Trump Admin's COVID-19 Testing Payment Guidance

Posted by Jane Anderson on Jul 23, 2020

As more employers turn to COVID-19 testing to see if employees are safe to return to the workplace, the Trump administration has clarified that insurers must cover only physician-ordered "medically necessary" diagnostic and antibody tests, AIS Health reported.

The guidance, released jointly on June 23 by HHS, the Dept. of Labor and the Dept. of the Treasury, also says self-funded employer plans must pay for COVID-19 testing that’s medically appropriate.
 
Read More

Topics: Industry Trends, Provider, Payer

Radar On Market Access: Insurers Are Required to Cover Only 'Medically Necessary' COVID-19 Tests

Posted by Jane Anderson on Jul 2, 2020

As more employers turn to COVID-19 testing to see if employees are safe to return to the workplace, the Trump administration has clarified that insurers must cover only physician-ordered "medically necessary" diagnostic and antibody tests, AIS Health reported.

The guidance, released jointly on June 23 by HHS, the Dept. of Labor and the Dept. of the Treasury, also says self-funded employer plans must pay for COVID-19 testing that’s medically appropriate.

Read More

Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: PBMs See Solid 1Q Results Despite Challenges Ahead

Posted by Jane Anderson on May 19, 2020

Major PBMs reported strong results for the first quarter of 2020 as members rushed to fill prescriptions in March ahead of the COVID-19 pandemic. However, financial analysts warn the pandemic could have unpredictable effects on PBMs' finances for the rest of 2020 and moving into 2021, AIS Health reported.

The 2021 PBM selling season could be disrupted in still-unknown ways, analysts said, and members are cutting back on routine physician visits and elective procedures, resulting in lower script volume overall.

Read More

Topics: Data & Analytics, Provider, Payer