From Medicare Advantage News - While some health plans and states participating in the huge CMS-backed demonstration for Medicare-Medicaid dual eligibles have struggled with its passive-enrollment emphasis, New Jersey’s own voluntary duals initiative begun in 2012 has avoided many of those difficulties. And a key reason for this, state officials say, is that New Jersey’s program is built around Medicare Advantage Special Needs Plans (SNPs) for duals. Read more
From Medicare Advantage News - This month’s $1 million fine levied by CMS against Aetna Inc. for erroneously listing nearly 6,000 retail pharmacies as in network for its Part D plans when they weren’t (MAN 1/22/15, p. 4) is the agency’s biggest financial penalty so far this year for violations related to drug benefits under Medicare. But it is far from the only one, as CMS in the first 100 days of the year has… Read more
From Medicare Advantage News - Pharmaceutical costs in Medicaid managed care programs that “carve in” pharmacy benefit management and thus let insurers handle it are 14.6% lower in terms of average net cost per prescription than in “carve-out” Medicaid states, according to a new study done for trade group America’s Health Insurance Plans (AHIP) by consulting firm The Menges Group. The study comes at a time when, as AHIP notes, some additional states are considering… Read more
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