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March 21, 2017

Hot Topic

Here’s a look at strategies insurers and PBMs are testing to reduce opioid misuse:

Insurers Are Blamed for Not Meeting ACA Rules, Delaying Opioid Addiction Coverage
The utilization management restrictions that health insurers place on opioid addiction treatments are making the national epidemic of heroin and other opioid abuse worse because tools like prior authorization are especially harmful to addicts, say substance abuse experts....

Cigna PA Change on Opioid Abuse Drugs Could Spark Similar Plan Modifications
A recent agreement between the New York attorney general and a major health insurer could have various ramifications on other plans — as well as their members — across the country....

Claims, Costs for Long-Acting Opioids Are Rising; Bills Could Give Huge Cost Boost
As the abuse and misuse of opioids became a national health problem, some state legislators began taking steps to curb this, passing legislation to require insurers to cover FDA-validated abuse-deterrent opioids, as well as put limits on their cost-sharing approaches for members....

World Congress
Today's AIS Health Datapoint

$26.63 ... is the average primary care physician copay for an on-exchange individual market silver plan, nationwide. For off-exchange individual market silver plans, that average jumps to $30.24.


Quote of the Day

CMS’s proposed Market Stabilization rule is a way for CMS to “scratch the back of insurers. Everything CMS could do with relative ease was included in this rule.”

— Austin Bordelon, a manager at Salt Lake City consulting firm Leavitt Partners, tells Health Plan Week

Click here to read the HEALTH PLAN WEEK article in which this quote appeared — "CMS’s Fixes Will Help, but Not Enough to Stabilize Exchanges" (Free for HPW subscribers; $17 for non-subscribers.)


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