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December 19, 2017
Hot Topic
With their limited geographic footprint, strong name recognition and broad provider networks, Blue Cross and Blue Shield plans face both challenges and opportunities in market positioning. Here’s a look at recent developments.
Blues plans in many states will continue to offer individual policies on the ACA exchanges, but high-profile state withdrawals by insurers such as Anthem, Inc. and Wellmark Blue Cross and Blue Shield will limit the overall Blues footprint on the individual market for 2018...
Most Blues plans underperformed in the MA and Part D star quality ratings for 2018, struggling in particular with certain clinical measures and the health plan rating measure...
Blue Cross and Blue Shield plans should prepare for a competitive Medicare AEP as national insurers begin to shift resources from individual commercial marketplaces in various states to the more profitable, more secure MA and Part D markets...
Today's AIS Health Datapoint
66% ... of Molina Healthcare members have access to Xyrem, a drug that can treat narcolepsy and sleep apnea, on the preferred tier (with prior authorizaton/step therapy). Among all payers and PBMs, only 11% of covered lives have preferred access to Xyrem, and an additional 10% have preferred access with PA/ST.
SOURCE: MMIT Analytics, as of Nov. 21, 2017
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Quote of the Day
“The higher enrollments aren’t a bad sign, but remember that to even break even on number of people enrolled in the exchanges, enrollment will have to be substantially higher through Dec. 15th than last year. To date, nothing that I’ve seen leads me to believe that enrollment will be higher than last year.”
— Chris Sloan, a senior manager at Avalere Health, tells AIS Health about projections for 2018 enrollment in health insurance exchanges.

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