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AIS's Value-Based Care News
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July 3, 2015

Today's Featured Story

FTC, OIG Signal More Scrutiny of Value-Based Pacts, Waivers, Risk
Reprinted from AIS's Value-Based Care News

Regulators from the Federal Trade Commission and the HHS Office of Inspector General are signaling increased scrutiny of accountable care organizations and other value-based payment arrangements, especially those making “creative” use of the antitrust and fraud and abuse waivers in place for Medicare ACOs..... Read Full Story


Quote of the Day

“Assuming the PCSK9 inhibitors are approved, the most important FDA decision will be for whom they approve this drug’s use. Will the FDA limit the approval to individuals at highest cardiovascular event risk, like those with familial hypercholesterolemia who are intolerant or resistant to statin therapy? Or will the FDA approve the PCSK9 inhibitors for anyone regardless of risk who is intolerant or resistant to a statin? Or will approval be somewhere in between?... Specialty drugs have typically been approved for use in small populations; the challenge with a specialty drug for the treatment of high cholesterol is that instead of one in 10,000 using the specialty drug for the condition, now 1 in 150 of all insured people may use the specialty drug at $10,000 a year. How do we ensure the pharmacy benefit remains affordable if one in 150 need to use a $10,000-a-year drug?”

— Patrick Gleason, Pharm.D., director of health outcomes at Prime Therapeutics 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

More than
75%... of health exchange enrollees who tried to find a doctor found it easy or somewhat easy, and 67% were able to schedule an appointment within two weeks, according to the latest tracking survey from The Commonwealth Fund.

Click here to read the INSIDE HEALTH INSURANCE EXCHANGES E-ALERT in which this datapoint appeared. (Free for HEX subscribers; $17 for non-subscribers).


Today from Washington

People on the Move

Assurex Health named Peter Donato senior vice president and chief financial officer. Donato was most recently executive vice president and chief financial officer for Bovie Medical....Lisa Diehl Vandecaveye, M.B.A., joined the Joint Commission as general counsel. She was previously senior vice president and chief corporate responsibility officer at Beaumont Health....Ampersand Capital Partners appointed Patrick Walsh CEO of Avista Pharma Solutions and Accuratus Labs. Walsh was formerly CEO of AAIPharma Services.


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