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The AIS Report on Blue Cross and Blue Shield Plans
Today’s issue is brought to you by The AIS Report on Blue Cross and Blue Shield Plans, a hard-hitting independent monthly newsletter on new products, market share, management strategies, profitability, strategic alliances and executive compensation of BC/BS plans. (Not affiliated with the Blue Cross and Blue Shield Association or its member companies.) Sign up for a $72 two-month trial subscription today.

December 28, 2016

Today's Featured Story

Court Can’t Stop Anthem From Moving PPO Members Into EPOs
Reprinted from THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS*

At a Nov. 15 hearing in Los Angeles Superior Court, a judge denied a temporary restraining order that would have prevented Anthem, Inc.’s California subsidiary from moving some of its individual PPO members into exclusive provider organization (EPO) plans, which don’t include coverage for out-of-network services. The judge, however, did acknowledge that Anthem Blue Cross violated federal law when it discontinued 2016 PPO policies and replaced them with EPO products for the 2017 plan year, says Laura Antonini, staff attorney at California-based Consumer Watchdog Group. The advocacy group recently filed a class-action suit on behalf of members who would lose PPO coverage at the beginning of the year. Anthem spokesperson Daryl Ng says the suit is “without merit.”... Read Full Story

* Not affiliated with the Blue Cross and Blue Shield Association or its member companies.

 

Quote of the Day

“The state-mandated formulary had the unintended consequences of driving up the use of more expensive brands and [disincentivized] the use of lower-cost generics. This, in turn, led to much higher drug costs for the health plans that were mainly driven by more expensive drugs and not because more beneficiaries were using medications. And when compared to a state Medicaid program that allows managed Medicaid health plans the flexibility to manage the formulary, we can infer that flexibility may go a long way in helping health plans and the state save money.”

— Krista Ward, senior director, government programs, Medicaid, at Express Scripts Holding Co., speaking about a recent study she co-authored. The study compared the impact of Florida’s decision to require Medicaid managed care companies to use a state-mandated preferred drug list rather than their own formularies.

From DRUG BENEFIT NEWS — "State-Mandated PDL Led to Rise in Drug Costs in Fla. Medicaid Program"

 

Today's Datapoint

37% ... of Humana’s enrollment is in public-sector plans. The insurer has 3 million Medicare Advantage members, 466,534 Medicaid HMO members and 207,511 Special Needs Plan members.

From AIS's MEDICARE AND MEDICAID MARKET DATA

 

Today from Washington

People on the Move

Cincinnati Children's Hospital Medical Center appointed Andrew Wooten vice president of its Center for Technology Commercialization. He most recently was the founding executive director of the Innovation Development Center at Baylor College of Medicine….The California Hospital Association said longtime President and CEO C. Duane Dauner will retire at the end of 2018. The association will launch a nationwide search for his successor….Quest Diagnostics said its board of directors elected President and CEO Stephen H. Rusckowski to serve as chairman of the board. He succeeds Daniel C. Stanzione, Ph.D., who was named lead independent director.

 

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Content questions or suggestions should be directed to Executive Editor Jill Brown at jbrown@aishealth.com. If you are interested in advertising in AIS's HEALTH BUSINESS DAILY, please contact BJ Taylor at bjtaylor@aishealth.com.

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