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From Health Plan Week - Several states have submitted new or amended 1115 Demonstration Waiver requests that would allow them to implement alternative models of Medicaid delivery to improve member outcomes (and therefore cut costs) by integrating primary care, behavioral health services and long-term care. Other states are seeking conservative reforms such as limited eligibility, benefit designs that mirror employer-sponsored coverage and work requirements. Read more

From Health Plan Week - Texas state officials concede that network adequacy problems arose when they switched to a new health plan for state employees on Sept. 1. In Wichita Falls, major providers sped through negotiations with Blue Cross and Blue Shield of Texas — selected in competitive bidding as the new third party administrator (TPA) for the Employees Retirement System (ERS) of Texas’s self-funded plans. That helped to avert major disruption to plan members… Read more

From Health Plan Week - Congress has set the stage for a September return to debate on stabilizing the individual health insurance market, with major changes to Medicaid funding or expansion taking a back seat. Read more

From Medicare Advantage News - Medicare Advantage and Part D sponsors appear to be sweetening the deal for potential and existing enrollees this Annual Election Period, as multiple companies are touting enhanced supplemental benefits beyond the usual fitness programs and dental coverage in addition to new provider partnerships and service areas, according to an AIS Health analysis of company press releases and marketing materials that have been released since Oct. 1. And despite the return… Read more

From Specialty Pharmacy News - In the first half of this year, Prime Therapeutics LLC’s total specialty trend for its commercial clients was 15.2%: a 3.7% increase in unit cost and an 11.5% boost in utilization. But, countered by a -5.1% total traditional trend, Prime’s overall drug trend was 0.8% when compared with the same period in 2016, according to its Fall 2017 Mid-Year Update, released Oct. 12. Read more

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