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Medicare Advantage News
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January 30, 2015

Today's Featured Story

NCPA, Aetna Trade Charges on Insurer’s ’15 Network-List Errors
Reprinted from Medicare Advantage News

It did not take long in 2015 for the first new Part D battle to erupt between a major insurer and a large trade group for independent retail pharmacies. The 23,000-member National Community Pharmacists Association (NCPA) on Jan. 7 rebuked Aetna Inc. for listing on the company’s websites and the CMS Medicare Plan Finder as in-network for 2015 numerous pharmacies that turned out not to be in most cases. Since Aetna did not admit or fix the problem until after the Annual Election Period ended Dec. 7, Part D beneficiaries may have been victims of “bait and switch” tactics, says NCPA’s senior vice president, public affairs, Kevin Schweers, who adds that CMS told the group Jan. 6 that affected beneficiaries would be allowed to switch plans.... Read Full Story


From the AIS Blogs

With the Hep C Class Managed, Express Scripts Looks to Cancer Drugs

After Gilead launched its hepatitis C treatment Sovaldi in late 2013 with a $1,000-per-day price tag, it seems like every day I’ve seen another article on this drug and how PBMs and payers are covering — or not covering — it. Then when the manufacturer brought Harvoni to the U.S. market in October with an even higher price, the din only increased.... Read more


Quote of the Day

“Smart payers are likely doing some modeling [of biosimilars] including identifying the pipeline products and comparing them to active patients. If/when a new biosimilar is approved, they could then move rapidly to promote a transition to the new product and start saving money. With the same information they should be modeling different drug utilization management strategies once these products hit the market, including whether there will be different prior-auth policies, benefit tiering/patient liability, etc.”

— Bill Sullivan, principal consultant with Specialty Pharmacy Solutions LLC, told AIS’s Specialty Pharmacy News.

Click here to read the SPECIALTY PHARMACY NEWS article in which this quote appeared. (Free for SPN subscribers; $17 for non-subscribers).


Today's Datapoint

27% ... less spending on compound medications was achieved by the PBM Catamaran Corp. across its book of business as a result of its program Safe & Effective Compound Reassurance Effort (SECURE).

Click here to read the DRUG BENEFIT NEWS article in which this datapoint appeared. (Free for DBN subscribers; $17 for non-subscribers).


Today from Washington

People on the Move

AltheaDx, Inc. named Noah Nasser senior vice president of sales. Nasser was most recently global sales leader for Verinata Health....The Blue Cross Blue Shield Association (BCBSA) promoted Scott Nehs to senior vice president of legal and governance, general counsel and corporate secretary. He was previously deputy general counsel and assistant corporate secretary....The National Health Council promoted Marc Boutin to CEO. Boutin was previously executive vice president and chief operating officer.


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