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May 16, 2017

Hot Topic

Here’s a look at Medicare Advantage plans’ efforts to build products that align with CMS’s Value-Based Insurance Design model:

MAOs Do Heavy Lifting to Stand Up VBID Models in Hopes of Achieving Outcomes
Implementing VBID programs under a new five-year test with CMS may be more difficult than some Medicare Advantage plans had expected...

Second Year of MA VBID Model Will Cover More States, Conditions
Before it’s even begun, the landmark VBID model for Medicare Advantage plans is getting a series of modifications for 2018...

2018 VBID Model MAOs May Tailor Benefits to Multiple Conditions
Plans participating in the second year of CMS’s VBID test will have additional flexibility when it comes to targeting members with multiple comorbidities and/or those with mood disorders...

Today's AIS Health Datapoint

$10.48 ... is the average in-network retail copay for generic drugs on silver level plans available from SHOP exchanges nationwide. $439.89 is the average in-network prescription deductible for plans using this cost-sharing strategy.


            Check out a demo of AIS Health's Health Insurance Exchange Database

Quote of the Day

“If the largest buyer in the market is sort of saying, ‘We’ve been hoodwinked,’ that is going to set off alarm bells for all the other buyers. There’s increasing evidence that the effect of PBMs and the rebate scheme is to increase the price of drugs, and this spotlights that.”

— David Balto, an antitrust attorney who has been critical of the PBM industry model, tells Drug Benefit News, speaking about the pricing dispute between Anthem Inc. and Express Scripts Holding Co.

Click here to read the DRUG BENEFIT NEWS article in which this quote appeared — "Anthem-Express Scripts Breakup Could Trigger Reshuffling in PBM Industry" (Free for DBN subscribers; $17 for non-subscribers.)


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