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Perspectives on Insulin Management

Posted by Leslie Small on Apr 18, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.

At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D "doughnut hole." 
 
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Topics: Industry Trends, Market Access, Data & Analytics, Provider, Payer

Radar On Market Access: CMS Finalizes Medicare Rates, Unveils '20 Opioid Policies

Posted by Judy Packer Tursman on Apr 18, 2019

CMS recently released its annual payment information and policy updates for Medicare Advantage, MA Prescription Drug (MA-PD) and stand-alone Prescription Drug Plans, underscoring the need for a better approach to opioid monitoring and management, AIS Health reported.

Yet overall, industry experts say perhaps the most eye-catching features of CMS's 2020 MA and Part D Rate Announcement and final Call Letter are the better-than-anticipated pay rate and the lack of worrisome new mandates, policy changes or major technical issues.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: BioScrip, Option Care Will Join Forces Within Infusion Market

Posted by Angela Maas on Apr 11, 2019

Two of the country's largest independent infusion services providers recently unveiled that they have entered into a merger agreement. After coming together, BioScrip, Inc. and Option Care Enterprises, Inc. would be the No. 2 home/alternate site infusion provider in the United States, AIS Health reported.

Under the terms of the deal, publicly traded BioScrip would issue new shares to Madison Dearborn Partners, LLC and Walgreens Boots Alliance, Inc., which are the Option Care shareholders, giving them 80% of BioScrip's stock, with current BioScrip shareholders holding the remaining 20%. The new company would be publicly traded.
 
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Topics: Specialty, Provider, Payer

Radar On Market Access: Drugmakers Are Trying Array of Tactics to Counter Copay Accumulator Programs

Posted by Angela Maas on Apr 9, 2019

As more health plans are implementing copay accumulator programs, manufacturers are struggling to find ways to counter them, AIS Health reported.

Drugmakers may want to "evaluate [their specialty pharmacy] network and consider narrowing it to independent SPs that will accept contracts precluding sharing with payers/PBMs the patients who are participating in your copay offset program," recommends a recent survey report from Zitter Insights.
 
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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Insurer Tools Aim to Help Members Save on Prescription Drugs

Posted by Leslie Small on Apr 4, 2019

As many Americans continue to struggle to afford their medications, health insurers and their PBMs are responding with tools that help consumers not only understand the cost of drugs before prescriptions are filled, but also find ways to spend less money on them, AIS Health reported.

However payers choose to design such tools, two keys to their success include making improvements over time and making sure members know about them before they might need them, according to Nathan Foco, senior director of market and sales intelligence for Michigan-based Priority Health.
 
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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: New Postpartum Depression Drug Presents Payer Challenges

Posted by Judy Packer Tursman on Apr 2, 2019

The FDA's recent approval of the first medication specifically aimed at treating postpartum depression is drawing a favorable response from clinicians, while payers could face challenges.

PBM executives tell AIS Health that the postpartum depression drug, Zulresso (brexanolone) injection, is likely to be covered under the medical, not the pharmacy, side of the benefit.
 
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Topics: Specialty, Market Access, Product Release, Provider, Payer

Trends That Matter for Cystic Fibrosis Medications

Posted by Jane Anderson on Mar 28, 2019

Payers typically use tools such as prior authorization and utilization review to manage cystic fibrosis treatments, but PBM experts say they are on the cusp of implementing more innovative strategies that might help to improve adherence while addressing the cost of cystic fibrosis drugs, AIS Health reported.

Cystic fibrosis, an inherited chronic disease that attacks the lungs and digestive organs, is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. CFTR modulators and other therapies carry a high price tag, typically costing $250,000 to $368,000 per year. Other drugs, most of which do not have generic equivalents, can add tens of thousands of dollars to that total.
 
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Topics: Specialty, Industry Trends, Market Access, Data & Analytics, Provider, Payer

Radar On Market Access: Colorado Soon Will Tighten Rules for Short-Term Plans

Posted by Judy Packer Tursman on Mar 28, 2019

Starting April 1, payers who decide to sell short-term limited duration (STLD) health benefit plans in Colorado must offer products covering essential health benefits mandated by state law — such as preventive services, prescription drugs, hospitalization and maternity and newborn care. Short-term plans also won't be able to deny applicants based on their health status: They must be guaranteed issue, AIS Health reported.

But one basic element will remain unchanged: STLD plans being sold in Colorado, as elsewhere, won't cover pre-existing conditions.
 
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Topics: Provider, Payer

Radar On Market Access: Magellan’s PBM Could Be Attractive Acquisition Target

Posted by Leslie Small on Mar 26, 2019

After weathering a rocky 2018 and facing public pressure from a hedge fund, Magellan Health Inc. appears more and more likely to end up on the selling block. Some say that if the company does opt for a sale, its PBM could be one of the most attractive assets to potential buyers, AIS Health reported.

On Feb. 22, the hedge fund Starboard Value — which owns approximately 9.8% of Magellan shares — sent an open letter to the company's shareholders suggesting new candidates for its board of directors and urging Magellan management to explore selling all or part of the company.
 
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Topics: Specialty, Provider, Payer

Radar On Market Access: As Insulin Prices Balloon, Insurers Try to Offer Some Relief

Posted by Leslie Small on Mar 21, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.

At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D "doughnut hole." 
 
Read More

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