From Drug Benefit News - According to the new Drug Trend Report from Express Scripts Holding Co., two primary contributors to drug trend last year were hepatitis C therapies and compounded medications. The PBM estimates that those two factors combined drove more than half of a 13.1% increase in overall spending; setting those classes aside, 2014 drug trend (defined as the year-over-year increase in per capita drug spending) was 6.4%. As forecasted last year, specialty trend — comprised of a 5.8% rise in utilization and a 25.2% increase in unit cost — more than doubled in 2014, to 30.9%. Read more
From Health Plan Week - Selling policies in the individual market was once a minor part of its business strategy, but Michigan’s Health Alliance Plan (HAP) now focuses on the segment, retooling and tweaking coverage options for three years running to better serve the state’s federally facilitated public exchange under its Personal Alliance brand. And as the 2015 open-enrollment period winds down, the insurer is once again looking at exchange dynamics, like what plans sold… Read more
From Inside Health Insurance Exchanges - Last fall, employees at AMN Healthcare selected health insurance plans and voluntary benefits through RightOpt, a multi-carrier private insurance exchange from Buck Consultants, a Xerox company. Employees, however, have no idea they are now part of an insurance exchange, said Lisa Larson, senior director of human resources operations at AMN Healthcare, a San Diego-based medical and physician staffing company that has 2,000 employees and 6,000 clinicians nationally. Read more
From Medicare Advantage News - On the surface, the changes in Medicare Advantage and Part D star quality ratings proposed by CMS in the 2016 draft Call Letter released Feb. 20 don’t seem large or surprising (MAN 2/26/15, p. 1). There is only a single new measure CMS intends to introduce for next year, and that one — regarding comprehensive medication reviews (CMRs) for plan members eligible for medication therapy management (MTM) programs — had… Read more
From Specialty Pharmacy News - The FDA approved the first biosimilar product, Sandoz Inc.’s Zarxio (filgrastim-sndz), earlier this month, and the industry expects more such approvals. So how should payers be preparing for this new class of drugs? In cases such as Zarxio’s in which the FDA grants indication extrapolation for a biosimilar (see story, p. 1), “Payers need to be really thinking through what it means for their commercial opportunities,” says Gillian Woollett, M.A., D.Phil.,… Read more
From Report on Medicare Compliance - When hospitals pay physicians handsomely for services provided to an unprofitable line of business, the government may suspect a Stark violation because the arrangement seems commercially unreasonable. But that misrepresents the way things work at nonprofit hospitals, which routinely use profits from healthier departments to keep money-losers afloat, a former prosecutor says. Read more
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