From Drug Benefit News - A new law enacted late last month will require all California health plans that provide prescription drug benefits to use a standard template to display their drug formularies. Both the health plans themselves and California’s exchange, Covered California, must provide links to these formularies. But health plan stakeholders argue that the law poses an administrative burden on plans and does nothing to address the rising cost of prescription drugs. Read more
From Health Plan Week - Last time out was a disaster. This time will be different. That is the hope of health insurers as they prepare to implement strategies for the second public exchange open-enrollment period beginning on Nov. 15 and running to Feb. 15, 2015. What health plans and strategists expect this time around is a more nuanced, knowledgeable approach to how things work, from how plans are priced and marketed to consumers to… Read more
From ACO Business News - It’s not easy to earn shared savings in either of Medicare’s accountable care organization programs: Only about one-quarter of Medicare Shared Savings Program (MSSP) ACOs will get a payout, along with half the Pioneers, financial and quality results released last month by CMS indicate. The results were positive for CMS, which was able to tout that 11 Pioneers and 53 MSSP providers had saved CMS $372 million while improving quality (see… Read more
From Medicare Advantage News - It was largely more of the same in the new National Committee for Quality Assurance (NCQA) rankings of Medicare Advantage plans. Kaiser Permanente plans occupied the first three places, as they did a year ago (MAN 10/10/13, p. 3). And not a single PPO made it into the top 23 in the rankings, which were released last month and again were prepared in partnership with Consumer Reports magazine. But while… Read more
From Drug Benefit News - In what it’s calling the first “real-world” look at Sovaldi (sofosbuvir) utilization patterns since the costly oral hepatitis C treatment hit the market late last year, CVS Health on Sept. 17 released data showing “a plateau and actual downward trend” in the number of new Sovaldi users from May to August 2014. Read more
From Report on Medicare Compliance - Providers who fail meaningful-use audits apparently will face a second audit in addition to having their entire incentive payment recouped for the audit period. They have just one shot at reversing adverse audit findings through the informal appeal process established by CMS under the Medicare-Medicaid electronic health record (EHR) incentive payment program. But there may be more wiggle room in practice than on paper, possibly to keep providers from losing… Read more
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