AIS's Health Business Daily
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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.

September 19, 2014

Today's Featured Story

To Ease the Move to Narrow Pharmacy Networks, Experts Advise Strong Communication
Reprinted from Drug Benefit News

Narrow pharmacy networks are becoming more commonplace throughout the market, as plan sponsors realize they can reduce prescription drug costs through improved dispensing fees and other discounts with little member disruption. But in order to successfully implement a narrow or tiered network, plans must deploy a varied communication strategy with both members and providers, advised three pharmacy experts during the Aug. 12 AIS webinar, “Health Plan/Employer Strategies for Implementing Narrow Pharmacy Networks....” Read Full Story


From the AIS Blogs

What's in a Compound? The Question Is More Like, What Isn't?

Earlier this year, the category of compounded medications became a top concern for payers as PBMs like Catamaran Corp. and Express Scripts Holding Co. identified unprecedented utilization and cost increases associated with these specialized drugs in 2013. As a result, many payers have undertaken efforts to control their use, but there are a lot of moving parts to this issue, as the compounding pharmacies argue that the industry has gotten a bad rap due to the questionable practices of some “bad actors....” Read more


Quote of the Day

“If you were appealing [Medicare claims denials] willy-nilly, without regard to whether you had a good case, taking [CMS’s offer of a 68% buyout] probably is a reasonable strategy. If you were being selective and only appealing the good cases, I wouldn’t take the settlement because you probably will win most of them.”

— Minneapolis attorney David Glaser, who is with Fredrikson & Byron, 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

$140 million ... were the combined operating losses of Massachusetts Medicaid plans since the start of 2014, $99 million of which was reported by Neighborhood Health Plan, the Boston Globe reported on Aug. 20.

Click here to read the MEDICARE ADVANTAGE NEWS article in which this quote appeared. (Free for MAN subscribers; $17 for non-subscribers).


Today from Washington

People on the Move

ZERO – The End of Prostate Cancer appointed Leo Giambarresi, Ph.D., to its board of directors. Giambarresi retired from the post of director of research for the American Urological Association Foundation earlier this year….Neurotrope, Inc. appointed Larry Altstiel, M.D., Ph.D., to the board of directors. He is also CEO of Provectra Therapeutics Inc….Trovagene, Inc. named Alberto Bardelli, Ph.D., to the scientific advisory board. He currently works in the oncology department of the Torino Medical School at the Institute for Cancer Research in Candiolo, Italy.


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