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April 13, 2011

Today’s issue is brought to you by AIS's Specialty Pharmacy News, a monthly newsletter designed to help health plans, PBMs, providers and employers contain costs and improve outcomes related to high-cost specialty products.

Today's Featured Story

New Highmark Pharmacy Policy Selects Preferred IG Therapy, Prompts Backlash
Reprinted from Specialty Pharmacy News

With no end in sight to the increasing costs for specialty therapies, insurers are taking a variety of approaches to try to staunch the financial hemorrhaging. But while the strategies may be based mainly on clinical considerations, with costs being at the bottom of the list of factors, the tactics are often met with a rash of negative publicity .... Read Full Story


From the AIS Blogs

Could Anything Replace the Individual Mandate?

Figuring out a replacement to the health reform law’s individual mandate — the edict that everyone must have insurance coverage — is a topic that health care policy wonks love to discuss, marinate, and debate over, ad nauseam ... Read more


Quote of the Day

“The Republican leadership says if we don’t move ahead [to implement an insurance exchange in Oklahoma] we’ll get a socialist health care system.”

— David Blatt, director of the Oklahoma Policy Institute, 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

9% … was the reduction in the overall rate of medical costs experienced by three medical practices in N.Y.-based CDPHP’s patient-centered medical home pilot.



Today from Washington

People on the Move

PinnacleHealth System in Harrisburg, Pa., named Michael Young president and CEO, effective June 1. Young will replace former Pinnacle CEO Roger Longenderfer, who retired last year. Young was president and CEO of Grady Health System and Grady Memorial Hospital in Atlanta....Infinity Pharmaceuticals, Inc. appointed Joshua Hamermesh vice president of business and corporate development. Hamermesh was senior vice president of strategy and corporate development at Pervasis Therapeutics, Inc.


Today's Featured Health Business Job Opening

Epic Management, L.P.
Chief Financial Officer
Redlands, Calif.

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Upcoming Webinars

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

Click here for details.

Outcomes-Based Contracts: Innovative Payer Deals to Improve Member Health and the Bottom Line
Tuesday, April 19, 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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New ACO Regulations: Discover the Opportunities and Pitfalls Ahead
Thursday, May 5, 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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Specialty Pharmacy News
AIS's Health Business Daily