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March 28, 2011

Today’s issue is brought to you by AIS's Medicare Part D News, monthly business, compliance and management news and strategies to help Part D plans increase enrollment, boost revenues and minimize their risks of CMS fines, penalties and repayments.

Today's Featured Story

CMS Proposes Treating Generic Samples Similar to OTC Drugs
Reprinted from Medicare Part D News

After maximizing traditional pharmaceutical cost-management approaches, Part D sponsors need new tools to improve drug utilization management and reduce costs. CMS has proposed aiding that effort by adopting a practice common in the commercial market: use of generic samples. CMS said in the 2012 draft Call Letter that Part D sponsors could count as administrative costs expenses related to generic samples provided in physicians’ offices if their use was consistent with a cost-effective drug utilization management program .... Read Full Story


From the AIS Blogs

New Compliance Risks Come With Value-Based Purchasing

The accuracy of clinical and patient-satisfaction data will become a bigger risk under value-based purchasing for hospitals, which starts to slowly kick in July 1 ... Read more


Quote of the Day

“I think there are a lot of people uncertain about health reform, but the antitrust uncertainty [related to accountable care organizations], I think, frankly is overblown. People pretty much know what the rules are.”

— Arthur Lerner, partner and co-chair of the law firm of Crowell & Moring LLP, told AIS’s Health Reform Week.

Click here to read the AIS's HEALTH REFORM WEEK article in which this quote appeared. (Free for HRW subscribers; $17 for non-subscribers).


Today's Datapoint

$21.5 million … was saved over a five-year period for every 10,000 members by employers that replaced their traditional health benefit plans with account-based health plans, according to a recent study conducted by Aetna Inc.



Today from Washington

People on the Move

Christopher Booth has been promoted to president of Excellus BlueCross BlueShield. Booth was executive vice president for commercial markets and health care affairs....Lexicon Pharmaceuticals, Inc., a biopharmaceutical company, named Pablo Lapuerta, M.D., chief medical officer. Lapuerta was vice president at Bristol-Myers Squibb.


Today's Featured Health Business Job Opening

Presbyterian Health Plan
Director, Provider Reimbursement
Albuquerque, N.M.

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Upcoming Webinars

Beyond Buy and Bill: Managing Specialty Therapies Under the Medical Benefit
Tuesday, March 29, 2011

Click here for details.

Medical Homes: Health Plan Pilots that Have Improved Outcomes and Lowered Costs
Thursday, March 31, 2011

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CMS’s New Past Performance Assessment: Steps MA and Part D Plans Must Take Now to Avoid Harsh Penalties
Thursday, April 14, 2011

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Setting Out-of-Network UCR Rates: Evaluating FAIR Health’s New Benchmark Data and Other Alternatives for Insurers and Employers
Thursday, April 21, 2011

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Medicare Advantage Marketing for 2012: Steps to Take Now to Succeed Amid Reform-Driven Changes
Tuesday, May 10, 2011

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Payer Strategies to Manage High-Cost Specialty Drugs That Will Hit the Market Soon
Thursday, May 12, 2011

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A Practical Guide to Federal Medical Loss Ratio Requirements
AIS's Health Business Daily