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From Inside Health Insurance Exchanges - When shopping for health coverage on public insurance exchanges, consumers typically have just two key data points on which to base their decision: the premium and the deductible. Those who haven’t previously purchased coverage on their own tend to choose the lowest-priced option. And that can be a costly mistake. Out-of-pocket costs for medical services and prescription drugs can vary up to 600% depending on the metal level of a chosen plan (i.e., bronze, silver, gold or platinum), according to the National Health Council (NHC), a non-profit patient advocacy group. Read more

From Health Plan Week - New moves by PBMs Express Scripts Holding Co. and CVS/caremark to stake out exclusionary formulary arrangements for managing the use of high-priced hepatitis C specialty drugs have health insurers measuring the impact of the deals, with an eye on how the competition may lower the cost for these treatments and others in the same class. One major carrier, Anthem Inc., on Jan. 8 joined the fray when it declared that favorable… Read more

From Inside Health Insurance Exchanges - A recent study concludes that an influx of new competitors participating on public exchanges helped keep coverage costs in check. Across all states, the average premiums for the second lowest-cost silver plans (i.e., the benchmark plan) sold on public exchanges were flat from last year, according to research from the National Opinion Research Center (NORC) and released last month by the Commonwealth Fund. For 2015, the average benchmark plan premium… Read more

From Medicare Advantage News - If 2014 was the year for simply overcoming the problems involved in getting the three-year CMS-backed Financial Alignment Initiative (FAI) for Medicare- Medicaid dual eligibles started, 2015 may be the year to start finding solutions for the obstacles — some of them unexpected — encountered in furnishing the integrated care duals need. Read more

From Drug Benefit News - Following last month’s approval of AbbVie Inc.’s hepatitis C therapy Viekira Pak (ombitasvir, paritaprevir and ritonavir tablets; dasabuvir tablets), both Express Scripts Holding Co. and CVS Health’s CVS/caremark PBM made bold but expected moves that are setting a new paradigm in formulary management of specialty drugs. Express Scripts on Dec. 22 unveiled what Chief Medical Officer Steve Miller, M.D., calls a “game-changing agreement” through which Viekira Pak will be the exclusive… Read more

From Report on Medicare Compliance - Medical College of Wisconsin agreed to pay $840,000 to settle false claims allegations that two of its teaching physicians charged Medicare for performing more than one neurosurgery at the same time, the U.S. Attorney’s Office for the Eastern District of Wisconsin said on Jan. 9. The case underscores the cluster of risks associated with billing by teaching physicians in connection with residents, which can send Medicare reimbursement on a downward… Read more

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