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October 10, 2017
Hot Topic
As CMS takes suggestions on how to refine its Medicare Advantage Value-Based Insurance Design model for the program’s third year, AIS Health is looking back at investments insurers have made to launch VBID plans.
Implementing value-based insurance design (VBID) programs under a new five-year test with CMS may be more difficult than some Medicare Advantage plans had expected....
In addition to expanding the Medicare Advantage VBID model to three new states and two more targeted clinical conditions for 2018, plans participating in the second year of CMS’s VBID test will have additional flexibility...
In an experiment to test VBID in MA as a means of improving quality and lowering costs in seven states, CMS will take the unusual step in MA of granting a limited waiver to the federal uniformity requirement for benefit design....
Quest Diagnostics

Today's AIS Health Datapoint
 54% ... of UnitedHealthcare members have access to migraine drug Relpax on the preferred formulary tier. Relpax appears on the preferred tier of 28% of all formularies, and is not covered by 15% of all formularies.
SOURCE: MMIT Analytics, as of Sept. 26, 2017

Quote of the Day
“The biggest issue is PBM contracts with employers are very opaque. There’s minimal transparency, and we’re trying to change that.”
— Cheryl Larson, vice president at the Midwest Business Group on Health, tells Drug Benefit News.

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