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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.



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.

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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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