From Specialty Pharmacy News - As cost concerns over new therapies continue to dominate the hepatitis C landscape (see story, p. 1), PBMs and specialty pharmacies are offering assistance on how health plans can make sure members are receiving appropriate care without breaking the bank. Burman’s HealthTrac medication therapy management software integrates all of a patient’s information so pharmacists and physicians can immediately see a patient’s status. Read more
From Health Plan Week - The “P” in Patient-Centered Medical Home (PCMH) is there for a reason, with the coordinated care of a patient front and center in the trendy population management model. But for nonprofit insurance carrier Independent Health, based in Buffalo, N.Y., the “P” also stands for physician, since the foundation of its successful PCMH — The Primary Connection — has centered on the cultivation of a crop of doctors who are interested… Read more
From Inside Health Insurance Exchanges - Federal tax credits, required guaranteed issue coverage and rising premiums are giving small employers more incentive to eliminate health benefits and encourage employees to shop on the public insurance exchanges, industry observers tell HEX. In response, insurance carriers and brokers are working on strategies to maintain relationships with those employers and workers…even as they transition to the individual market. Case in point: During the first nine months of 2014, Anthem, Inc. Read more
From Medicare Advantage News - There were few surprises and only one brand-new measure — but some important potential changes — outlined in CMS’s Nov. 21 memo on proposed “enhancements” to its Medicare plan star quality ratings for 2016 and beyond. This year’s 22-page edition of what has become an annual document makes clear, for instance, that CMS intends finally to end use of predetermined four-star “thresholds” effective with the 2016 ratings. Read more
From Drug Benefit News - As the prices of many generic drugs continue to experience increases due to shortages, reduced competition and other potential factors, the federal government is putting the pressure on the generic pharmaceutical industry. Sen. Bernie Sanders (I-Vt.), chairman of the Senate Subcommittee on Primary Health and Aging, on Nov. 20 convened a Senate hearing to investigate the “skyrocketing” prices of generic drugs at which three generic drugmakers were no-shows. Read more
From Report on Medicare Compliance - An orthopedic surgeon who allegedly performed spinal fusions but didn’t bother to implant the device that’s part and parcel of the procedure — and then billed Medicare and Medicaid anyway — was charged Nov. 24 with health care fraud, the U.S. Attorney for the Eastern District of Michigan says. Aria Sabit, M.D., of Bloomfield Hills, Mich., was accused of billing Medicare, Medicaid and Blue Cross Blue Shield of Michigan tens of… Read more
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