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February 21, 2018

Today's Featured Story
 
Employer Alliance Launches Contracts to Tackle Health Costs
 
Health Transformation Alliance (HTA), a nonprofit cooperative, launched group contracts with managed care companies and PBMs to cover 7 million employees, dependents and retirees starting Jan. 1, 2018.
 
HTA is comprised of 46 large self-funded companies that together spend about $27.5 billion annually on health care. It is expected to save at least $600 million in total over the three-year contracts with PBMs CVS Health Corp. and UnitedHealth Group’s OptumRx. On the medical side, HTA offers what it describes as networks of select, high quality providers and uses UnitedHealthcare and Cigna Corp. to administer the value-based networks.
 
Former congressman Robert Andrews (D-N.J.), the alliance’s CEO, says his group goes beyond sharing best practices. “I don’t know of any other employer coalition buying health care,” he says. “We’re a business that operates in order to provide better health results and savings, and we finance the operations of our cooperative through those savings.”
 
HTA negotiated the contracts with CVS Health and Optum, yet whether to participate is up to the members. If they do, they could modify the template “and do what they like,” he says.
 
Andrew says his group will also provide data to IBM’s Watson Health to identify the most effective treatments. Looking forward, HTA’s next step is to find the “best drugs” for specific conditions. “We’re working on making a tool available to all members for doctors to see information on the patient and the relative efficacy of the drug,” he says. On the medical side, HTA is looking at pre-diabetes care, making telemedicine work better and offering reference pricing programs.  
 
Jay Godla with Strategy&, PwC’s strategy consulting practice, sees promise in HTA’s approaches, yet he also notes they are not transformative. “None of this is new. [W]anting to cut waste, break the bad habits of individuals…all those things are great and they will get there, but it’s a journey,” he says.
 
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Today's AIS Health Datapoint
 
3,309,732 is the number of lives enrolled in WellCare Health Plans in the U.S. The insurer reported its net income margin for the full-year 2017 as 2.2%, a 50 basis point improvement compared to full-year 2016.
 

Quote of the Day
 
“To date, biosimilars have not really impacted the rheumatoid arthritis space. It varies with payers, but Remicade has held its own so far this year….[But] we expect the biosimilars to get much better placement on formularies for 2018.”
 
— Daniel Kus, B.S.Pharm., R.Ph., vice president at Pharmacy Advantage Specialty Pharmacy, and Katherine Lewnau, Pharm.D., autoimmune specialist at the company, tell Radar on Specialty Pharmacy.
 
Subscribers may read the RADAR ON SPECIALTY PHARMACY article in which this quote appeared online. Learn more about subscribing to AIS Health's publications.

March 15 free webinar with Magellan Rx ManagementThe top 25 medical benefit drugs = 62% of total commercial PMPM. For Medicare it was even higher!
 
Learn more about this and other interesting trends. Join us for a complimentary webinar sponsored by Magellan Health on March 15, 2018 at 1pm Eastern, as leaders from Magellan Rx share key findings from Magellan Rx Management’s eighth edition of the Medical Pharmacy Trend Report™: The industry’s only source for key trends and benchmarking of one of the nation’s biggest drivers of specialty spend, provider-administered infused or injectable medical benefit drugs. Register today at https://aishealth.com/magellan-webinar-0318!
 

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