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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.



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



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.



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.



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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Topics: Industry Trends, Market Access, Payer