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May 2, 2011

Today’s issue is brought to you by Drug Benefit News, biweekly news, proven cost management strategies and unique data for health plans, PBMs, pharma companies and employers.

Today's Featured Story

PBMs Confront Would-Be Pharmacist Regulators on Mississippi Battlefield
Reprinted from Drug Benefit News

Since the beginning of this year, Jackson, Miss., has been the flashpoint in a divisive conflict pitting the state’s lawmakers against drug benefit managers. Lawyers and lobbyists for several of the country’s largest PBMs descended on the state capitol to halt the progress of a bill that would put pharmacy benefit management activity under the regulatory authority of the Mississippi Board of Pharmacy — but to no avail. The bill sits on the desk of Gov. Haley Barbour (R), waiting to be signed into law. Barbour had said earlier this year he would veto the bill .... Read Full Story


From the AIS Blogs

Good and Bad News for Audited Organizations with Multiple Contracts

Medicare Part D sponsors need to familiarize themselves with CMS’s Past Performance Assessment for 2012. Although the agency has been using past performance assessments to identify plan outliers before now, the new assessment establishes 11 distinct categories used to evaluate plan performance .... Read more


Quote of the Day

“I think the standards that CMS has established for participation in [Accountable Care Organizations] are likely to become standards that are utilized heavily in the commercial sector…. There’s a tremendous legal benefit in utilizing the Medicare standards in the commercial market from an antitrust, and even to some degree, from a fraud and abuse standpoint.”

— Bob Belfort, partner in the health care practice at Manatt, Phelps & Phillips, LLP, told AIS’s Health Reform Week.



Today's Datapoint

40%…is the target for reductions in preventable hospital-acquired conditions (with a 20% reduction in unnecessary hospital readmissions) under Partnership for Patients, a new public-private initiative under the reform law.



Today from Washington

People on the Move

BioPlus Specialty Pharmacy named Russell Gay chief strategic officer. Gay was a principal at 2020 ConsultRx LLC and serves as executive director of the Independent Specialty Pharmacy Coalition.…Community Specialty Pharmacy Network appointed Nick Calla vice president of industry relations. He was vice president of trade relations for Walgreens Specialty Pharmacy.


Today's Featured Health Business Job Opening

Arcadian Health Plan
Clinical Pharmacist
San Dimas, Calif.

Place Your Ad Here

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Upcoming Webinars

New ACO Regulations: Discover the Opportunities and Pitfalls Ahead
Thursday, May 5, 2011

Click here for details.

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

Click here for details.

Strategies for Managing Part D Specialty Formulary Tiers
Wednesday, June 15, 2011

Click here for details.

Insurance Exchanges: How Health Plans and Employers Should Prepare for the Radical Changes Ahead
Tuesday, June 21, 2011

Click here for details.

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

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AIS's Directory of Health Plans: 2011
Also From AIS
A Guide to Health Insurance Reform: Benefit Design Regulation Under Federal Reform
Track, understand and comply with dozens of reform-driven federal rules. Click here for details.

AIS’s Quarterly Pharmacy Benefit Survey Results
Track growth and consolidation in the industry, and trends in costs, utilization and benefit design. Available quarterly as Excel spreadsheets! Click here. 1st Quarter 2011 data now available!
AIS's Health Business Daily