AIS's Health Business Daily
Strategic Business News from Experienced Health Care Reporters
at Atlantic Information Services, Inc.
Drug Benefit News
Today’s issue is brought to you by Drug Benefit News, biweekly news and proven cost management strategies for health plans, PBMs, pharma companies and employers.

July 31, 2014

Today's Featured Story

New CMS Marketing Guidelines Seek to Encourage Greater Medication Therapy Management
Reprinted from Drug Benefit News

Although CMS dropped its previous proposal to significantly expand medication therapy management (MTM) from the final Medicare Advantage (MA) and Part D rule issued in May, the new plan marketing guidelines released a month later appear to encourage more widespread use of those programs without mandating them. Nevertheless, CMS’s new guidelines may not have the same intended effect as requiring plans to expand MTM eligibility.... Read Full Story

 

Quote of the Day

“The government will pick apart [physician] compensation plans if they weren’t perfectly done. Stark is a persnickety law and if you don’t do it right, the consequences can be huge.”

— Jeffrey Fitzgerald, with the Denver law firm of Polsinelli, told AIS’s Report on Medicare Compliance.

Click here to read the REPORT ON MEDICARE COMPLIANCE article in which this quote appeared. (Free for RMC subscribers; $17 for non-subscribers).

 

Today's Datapoint

More than
$65 billion ...
a year is being spent by the nation’s 37 independent Blue Cross and Blue Shield plans (about $1 for every $5 spent on medical claims) in financial incentives aimed at improving patient outcomes while reducing waste in care delivery, according to the BCBS Association.

From THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS.*
* Not affiliated with the Blue Cross and Blue Shield Association or its member companies.

 

FierceHealthPayer News from our partner FierceMarkets

What auto-enrollment for exchanges means for insurers

The U.S. Department of Health and Human Services recently proposed a plan to automatically renew customers' current marketplace plans unless people opt out of them. While the new rule aims to improve the customer experience, changes to the renewal process could lead to "painful" repercussions for insurers, according to a new report from Milliman.... Read more

 

Today from Washington

People on the Move

Aegerion Pharmaceuticals, Inc. promoted Craig Fraser to chief operating officer. He previously was president, U.S. and international commercial and global manufacturing and supply chain at Aegerion. The company also promoted Carolina Alarco to president, international and Johanna Sealscott to vice president, U.S. sales. Ms. Alarco previously was vice president and general manager, international, and Ms. Sealscott was regional sales director for JUXTAPID….Matrix Medical Network appointed Lori LeGrow vice president, contact center operations. She previously was a call center executive at Ultimate Medical Academy.

 

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Upcoming Webinars
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Avoiding Costly Part D Sanctions: Rx Access Strategies for Plans and PBMs
Tues., Aug. 5, 2014
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Private Exchange Strategies for Insurers: What’s Working? What’s Not?
Wed., Aug. 6, 2014
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Health Plan/Employer Strategies for Implementing Narrow Pharmacy Networks
Tues., Aug. 12, 2014
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Stark Law DOs and DON’Ts: Best Practices for Your Physician Contracts
Thurs., Sept. 18, 2014
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Dual-Eligibles Programs: Initial Results, Successes and Remaining Challenges
Specialty Pharmacy Trends and Strategies: 2014