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April 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

Court Requires Part D Plans to Cover Cost Of Medically Necessary Off-Label Drugs
Reprinted from Medicare Part D News

The discussion surrounding off-label coverage of Part D drugs is back on the table with two recent developments — reintroduction of the Part D Off-Label Prescription Parity Act and a court ruling that Part D plans should cover medically necessary off-label prescription drug costs. Although the court case does not have the effect of law, one health care consultant says the decision will “have a huge impact on plans.”... Read Full Story


From the AIS Blogs

Compliance Programs, Self-Disclosure Mandated in ACO Rule; Concerns Raised

There’s no escaping the federal government’s determination to bake compliance programs into the health care industry. On top of the compliance-program mandate in the health reform law, the new proposed CMS regulation for accountable care organizations (ACOs), announced March 31, requires them to have a compliance officer. The ACO compliance officer cannot also be the ACO’s legal counsel ... Read more


Quote of the Day

“Twenty million seniors have either diabetes or pre-diabetes, and they don’t know it…and their conditions are getting worse.”

— Christopher Porter, senior director of government affairs at Novo Nordisk, 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

$403 billion … is the staggering amount that is wasted annually as a result of consumer behavior related to pharmaceuticals, with $258 billion alone wasted on nonadherence, according to Express Scripts, Inc.’s 2010 Drug Trend Report.

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


FierceHealthPayer News from our partner FierceMarkets

Anthem's Rate Appeal Dismissed by State Supreme Court

The Maine Supreme Judicial Court has thrown out Anthem Health Plan of Maine's appeal of the state's decision to limit its 2009 rate increase for individual policies to 10.9 percent, reports Mainebiz... Read more


Today from Washington

People on the Move

Cetero Research, an early-stage contract research organization, named Jay Dixon senior vice president of quality and compliance. Dixon was vice president of quality compliance at MedImmune, LLC....HealthPlan Services appointed James Vertino chief information officer (CIO) and executive vice president of technology. Vertino was vice president of systems and technology and acting CIO for CareSource.


Today's Featured Health Business Job Opening

TriWest Healthcare Alliance
Manager-Direct Contracting-Alaska
Anchorage, Alaska

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Upcoming Webinars

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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Optimizing Drug Benefit Plan Designs for the Coming Wave of Generic Competition
Tuesday, May 17, 2011

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Medical Loss Ratio Regs: What 2010 Data Suggest About Potentially Huge Rebates in 2011
Thursday, June 23, 2011

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A Practical Guide to Federal Medical Loss Ratio Requirements
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