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July 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

Medicare Home Infusion Bill Is Reintroduced, but Future Is Unclear
Reprinted from Specialty Pharmacy News

Once again a bill that would fill the gap in home infusion coverage for Medicare Part D beneficiaries has been introduced in both houses of Congress. But there is no indication that the bill has a better chance of passage now than when attempts to close the coverage gap were made in 2006, 2007 and 2009. However, a pair of associations supporting the bill hopes to use the legislation to get a demonstration or pilot program started .... Read Full Story


From the AIS Blogs

Settling Providers Pay for IROs, but the Firms Serve Another Master

Providers settling health care fraud allegations with government agencies usually have to cough up big bucks to hire internal review organizations (IROs), which act as compliance monitors to ensure the provider doesn’t lapse into noncompliance habits. Although the IRO is being paid by the provider, it acts as the fly on the wall for the HHS Office of Inspector General (OIG) and increasingly for some states ... Read more


Quote of the Day

“I really think that CMS was remiss in not explicitly including the drug benefit in the Shared Savings model. Because the industry recognizes that it’s important, what we are seeing is that the people who are planning on participating in the ACOs are already reaching out to the PBMs to lean on them to develop programs. So by default, we will end up being participants in it indirectly versus directly…. It’s the most frequently used benefit. It’s hard to imagine that you’ll be able to have a successful ACO model without considering the effects of somebody involved in health outcomes.”

Brit Pim, VP and general manager of the Medicare/Medicaid division of Express Scripts, Inc., told AIS’s Drug Benefit News.

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


Today's Datapoint

16% … was the increase in the total adjusted annual mail-order drug volume (to 776 million) as of the first quarter of 2011, compared to the prior year figure of 668 million, according to data from AIS’s quarterly survey of PBMs and related companies.



Today from Washington

People on the Move

BlueCross BlueShield of Tennessee named Donald McArtor director of its project management office and promoted Ron Cooper to director of information systems security and compliance. McArtor was senior project manager at Rockwell Collins and Cooper was manager of compliance and risk....Tris Pharma, a specialty pharmaceutical company, named Cheryl Patnick vice president of human resources. Patnick was president at Capella Consultants LLC.


Today's Featured Health Business Job Opening

Blue Shield of California
Chief Privacy Official
San Francisco

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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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Managing Oncology Drugs: New Challenges and Payer Solutions
Tuesday, August 23, 2011

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Specialty Pharmacy News
AIS's Health Business Daily