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Aug. 8, 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

Payers Need Better Specialty Focus; Employers Want to Know Value
Reprinted from Specialty Pharmacy News

With literally hundreds of drugs in the specialty pharmaceutical pipeline, now is the time for payers to make sure they have strategies in place to manage these therapies, according to speakers at a recent AIS webinar. But employers are growing wary of paying for these therapies, contended one speaker, and may use health reform as a way to avoid covering specialty drugs .... Read Full Story

 

From the AIS Blogs

PBM Wars: Companies Plan Their Next Move

It will be a while before we know the outcome of Express Scripts, Inc.’s proposed acquisition of Medco Health Solutions, Inc. The deal, of course, will undergo rigorous scrutiny from the FTC. Nevertheless, the industry is buzzing about how the PBM landscape would change if the deal indeed goes through. How will the creation of such an industry giant impact the competition among the top-tier players? ... Read more

 

Quote of the Day

“If the higher trend [in Medicare Advantage enrollment] in July continues, then I think that would be a decent sign that you’re starting to see the number of seniors that are aging into the program increase….Next year is supposed to be the first year with a significant increase because of baby boomers, so that would certainly contribute to a bigger increase in 2012 than we saw this year.”

— Carl McDonald, securities analyst with Citigroup Global Markets, told AIS’s Medicare Advantage News.

Click here to read the MEDICARE ADVANTAGE NEWS article in which this quote appeared. (Free for MAN subscribers; $17 for non-subscribers).

 

Today's Datapoint

$4.90 … is already a “borderline inadequate” payment to pharmacies to dispense drugs under Medicaid, according to U.S. District Judge Tanya Walton Pratt, who temporarily blocked Indiana from cutting the payment from $4.90 to $3.00.

From DRUG BENEFIT NEWS.

 

Today from Washington

People on the Move

Anthem Blue Cross and Blue Shield in Colorado named Mike Ramseier president, effective Sept. 1. He replaces John Martie, who was appointed president of Anthem National Accounts earlier this year. Ramseier now serves as vice president, provider engagement and contract, for Anthem Blue Cross of California....Mountain View Regional Hospital in Casper, Wyo., hired William Stangl as CEO. Stangl was the administrator at Mount Nittany Surgical Center in State College, Pa.

 

Today's Featured Health Business Job Opening

Whatcom Alliance for Healthcare Access
ACO Project Analyst/Coordinator
Bellingham, Wash.

Place Your Ad Here
 

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

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 http://www.magnetmail.net/actions/ 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 rbiehl@aishealth.com.

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Upcoming Webinars
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Value-Based Pharmacy Benefits: How to Increase Medication Adherence and Return on Investment
Wednesday, August 10, 2011

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

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New Insurance Exchange Regs: Strategies for Health Plans, Brokers, Providers and Employers
Wednesday, August 24, 2011

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Hot Spots in the 2012 IPPS Regulation: Practical Strategies for Compliance Officers
Tuesday, August 30, 2011

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New Reform-Driven Claims and Appeals Procedures: Practical Steps Plans Should Take Now
Tuesday, September 13, 2011

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Encounter-Data Requirements for Medicare Advantage: How to Get Ready for the Huge Change in January
Wednesday, September 14, 2011

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Social Media Strategies for Insurers: How to Optimize Health Plan Online Efforts
Thursday, September 22, 2011

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Update for Agents and Brokers: New Reform-Driven Opportunities and Pitfalls
Tueday, September 27, 2011

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Specialty Pharmacy News
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A Comprehensive Guide to Managing Never Events and Hospital-Acquired Conditions
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A Practical Guide to Federal Medical Loss Ratio Requirements
Guidance on the big-dollar questions stemming from provisions in the health reform law that set minimum medical loss ratios. Click here for details.
 
AIS's Health Business Daily