Visit the All-new
With archives of AIS's Health Business Daily,
New features like the News Archives, AIS Blogs and more!
(Free registration required)

May 6, 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

CVS Caremark Says It Will Manage Medical Benefit, Joins Other PBMs With Service
Reprinted from Specialty Pharmacy News

CVS Caremark Corp. says it will begin managing drugs under the medical benefit in 2012, making it the latest PBM to offer such a service .... Read Full Story


From the AIS Blogs

Is the End of the Coverage Gap Discount Near?

When a 50% manufacturer discount on brand-name Part D drugs in the coverage gap was included in the health reform law, it was the culmination of a “deal” forged between the White House and the pharma industry. Manufacturers would agree to give discounts to Medicare beneficiaries on brand-name drugs and provide more than $80 billion to the Part D program, while the White House promised to not require manufacturers to accept Part D rebates. Now some say the deal is coming to an end ... Read more


Quote of the Day

“You could argue that while on one hand the [reform] law gave the government a million new tools to fight fraud within [Medicare and Medicaid], the [medical loss ratio] rules are written in a way that create disincentives for doing anti-fraud activity on the private side. The MLR rule certainly hasn’t helped, and we can debate whether it’s neutral.”

— Kirk Nahra, an attorney with the Washington, D.C., law firm of Wiley Rein LLP, told AIS’s Health Plan Week.

Click here to read the HEALTH PLAN WEEK article in which this quote appeared. (Free for HPW subscribers; $17 for non-subscribers).


Today's Datapoint

$193 million … in rebates would have been owed by UnitedHealth Group’s Golden Rule Insurance Co. subsidiary under health reform’s minimum medical loss ratio provisions, according to an analysis of 2010 data by Carl McDonald of Citigroup Global Markets.

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


Today from Washington

People on the Move

WellPoint, Inc. named John Martie president and CEO of its National Accounts business. He replaces John Langenus, who recently retired. Martie was president of WellPoint's Colorado local group plan....SCAN Health Plan appointed Christopher Wing president and CEO. Wing was executive vice president and chief operating officer at HealthCare Partners.


Today's Featured Health Business Job Opening

Health Plan
Medical Director
Los Angeles

Place Your Ad Here

Content questions or suggestions should be directed to BJ Taylor, editor of AIS's HEALTH BUSINESS DAILY, at If you are interested in sponsoring AIS's HEALTH BUSINESS DAILY, please contact Bailey Sterrett at

AIS's HEALTH BUSINESS DAILY is copyrighted and protected by federal law. The re-use of its content is restricted (see below). However, you are permitted to forward this e-mail to as many of your friends and colleagues as you wish, or better yet have them sign up for their own copy at atlantic_subscription.cfm, where you can also sign up for AIS's Government News of the Week. Copyright © 2011 Atlantic Information Services, Inc. (AIS). All rights reserved. It is not permissible to include all or any portion of this content on any Web site, intranet or electronic network or in any print publication, without AIS's written permission in advance. Permission requests should be directed to

AIS E-Savings Club Weekly Specials

Upcoming Webinars

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

Click here for details.

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

Click here for details.

Specialty Pharmacy News
Also From AIS
New from AIS – Inside Health Insurance Exchanges
Hard-hitting news and strategies on the details of state health insurance exchanges, that will help you succeed in the insurance marketplace of tomorrow. Click here for details.

Managed Medicare and Medicaid Factbook 2011
Get up-to-date enrollment data, benefit designs, directories, trends and strategies on the Medicare Advantage, Medicare Part D and managed Medicaid programs. Learn more.
AIS's Health Business Daily