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June 20, 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

WellPoint Expands Value-Based Benefit Design With Paid Pharmacist Interventions
Reprinted from Drug Benefit News

Although medication therapy management (MTM) is a requirement of Medicare Part D plans, it has been slower to catch on in the commercial sector. But one health insurer has made MTM an integral part of a value-based benefit-design pilot that now is being expanded to several more sites .... Read Full Story


From the AIS Blogs

How Closely Are Payers Watching CMS’s Provenge NCD?

By the end of the month, CMS will issue a National Coverage Determination (NCD) on the prostate cancer therapy Provenge (sipuleucel-T). A proposed decision memo issued in March indicated that “the evidence is adequate to conclude” that on-label use of the therapy is “reasonable and necessary.” ... Read more


Quote of the Day

“The fear factor shouldn’t be the impetus not to talk to the government [when considering a self-disclosure]. It’s better to engage them than to be afraid to engage them.”

— Robert DeLuca, principal in Forensicorp, told AIS’s Report on Medicare Compliance.

Click here to read the REPORT ON MEDICARE COMPLIANCE article in which this quote appeared. (Free for RMC subscribers; $17 for non-subscribers).


Today's Datapoint

2%…of revenue is the new limitation on profit that can be made by Blue Shield of California, after which excess profit must be returned to customers.



Today from Washington

People on the Move

WellPoint, Inc. named Harlan Levine, M.D., executive vice president of comprehensive health solutions. Levine was a national practice leader at Towers Watson....Profil Institute for Clinical Research, Inc. promoted Andrew Krentz to senior director of scientific services. Krentz was a senior scientific consultant.


Today's Featured Health Business Job Opening

B. E. Smith
Director of Risk Management
Sioux Falls, S.D.

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Insurance Exchanges: How Health Plans and Employers Should Prepare for the Radical Changes Ahead
Tuesday, June 21, 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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Commercial ACO Results and Strategies: A Case Study in Three-Way Risk Sharing
Thursday, June 30, 2011

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Accounting for HIPAA Disclosures in EHRs: How to Comply with Onerous New HHS Rules
Thursday, July 7, 2011

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Health Plans vs. Drug Coupons: Tactics to Combat Brand-Name Drug Promotions
Wednesday, July 13, 2011

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Payer Strategies to Manage High-Cost Specialty Drugs That Will Hit the Market Soon
Thursday, July 14, 2011

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Managed Medicare and Medicaid Factbook 2011
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