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From Drug Benefit News - As health plans and PBMs keep close watch on biologics in the pipeline, one area that’s creating a certain amount of anxiety is an emerging class of cholesterol-lowering drugs known as PCSK9 inhibitors. Also referred to as “super statins,” these injectable agents could significantly raise costs in a therapeutic category that is one of the most widely prescribed in the U.S. Read more

From Health Plan Week - An aging population, along with implementation of the Affordable Care Act’s essential health benefits provision, could soon shine a spotlight on the issue of hearing health care and hearing aid insurance, a benefit commonly left out of traditional commercial health plans and specifically excluded from Medicare. Read more

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… Read more

From Medicare Advantage News - Providers in Humana Inc.’s Accountable Care Continuum programs in Medicare Advantage got much higher HEDIS scores than did its providers outside of those settings in Medicare, and the scores improved as the degree of provider risk-bearing increased (see chart, this page), the company said this month. The comparisons also showed that Humana’s MA members in accountable care programs had 7% fewer emergency room (ER) visits per 1,000 patients and 4%… Read more

From Specialty Pharmacy News - As more and more genetic tests hit the U.S. market, companies are trying to ensure that these tests are used appropriately, reducing waste and improving outcomes. With this in mind, NIA Magellan is teaming with InformedDNA on a genetic benefits optimization solution. “Genetic testing is one of the most clinically complex and rapidly growing areas of spend — from 20% to 100% annually, depending upon the payer,” senior executives at both… 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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