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April 25, 2017

Hot Topic

Health insurers are growing more comfortable with outcomes-based contracts with drug manufacturers that tie reimbursement to adherence, efficacy or other measures.

Deep Dive on Use, Persistency Data Can Help With Contracting
Armed with data from a pair of studies, Prime Therapeutics LLC is approaching manufacturers to see if they’d be willing to enter into innovative new contracts with the PBM....

Cigna Makes Deals With Pharma to Base Contracts on Drug Outcomes
Continuing to extend value-based contracting to its prescription drug business, Cigna Corp. signed two separate deals with Amgen Inc. and Sanofi S.A./Regeneron Pharmaceuticals, Inc. for their PCSK9 inhibitors for commercial business....

New Harvard Pilgrim Pacts on Entresto, Trulicity Propel P4P Pharmacy Deals
Adding to its growing roster of pay-for-performance deals, Harvard Pilgrim Health Care, Inc. has reached agreements with Novartis and Eli Lilly & Co. to evaluate the effectiveness of the drugmakers’ respective heart failure and diabetes drugs....

Today's AIS Health Datapoint

35.84% ... is the average coinsurance for the Rx specialty tier, in-network, for silver plans on 2017 individual marketplaces. The average copay for these plans is $127.02. Plans vary as to whether they require a deductible to be paid before cost-sharing begins.


            Check out a demo of AIS Health's Rx benefit database

Quote of the Day

“Hiring someone from the provider side can give the carrier more credibility. They can teach them the nuts and bolts of health plan medical management later. They need to know they’re not just being hired as window dressing, that they’ll actually have an impact on care.”

— Heidi Leeds, who runs the Global Health Insurance Practice at executive recruiting firm Korn Ferry, tells Health Plan Week.

Click here to read the HEALTH PLAN WEEK article in which this quote appeared — "Evolving Payment Models Prompt Carriers To Adjust Hiring, Outsourcing Patterns" (Free for HPW subscribers; $17 for non-subscribers.)


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