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From Radar on Medicare Advantage - As CMS prepares to expand its Medicare Diabetes Prevention Program (MDPP), Medicare Advantage (MA) organizations are busily working to set up adequate benefits and provider networks. “Any new benefit that’s covering all of their beneficiaries is a big lift for a health plan because it touches so many parts of their organization. And the expanded MDPP is creating a unique set of issues for MA plans for a variety of reasons,” Brenda Schmidt, founder and CEO of Solera Health, told AIS Health. Read more

From Health Plan Weekly - A coalition of 17 Democratic state attorneys general, led by the AGs in New York and Massachusetts, expressed their concerns about the Dept. of Labor’s draft rule to expand the use of so-called Association Health Plans (AHPs) in a 22-page comment. Read more

From Health Plan Weekly - Iowa’s state lawmakers recently advanced a bill that would allow the Iowa Farm Bureau Federation (IFBF) to offer non-ACA-compliant health coverage administered by Wellmark Blue Cross and Blue Shield of Iowa. “It’s one more state trying to provide options other than an ACA compliant plan to their constituents,” says attorney Christopher Condeluci, a former Republican staffer for the Senate Finance Committee during the ACA’s drafting. Read more

From Radar on Medicare Advantage - Since last year, L.A. Care Health Plan has partnered with the California Long-Term Care Education Center (CLTCEC) to provide training and education to In-Home Supportive Services (IHSS) caregivers of its Cal MediConnect dual-eligible enrollees. “We recognize that quality health care doesn’t happen only in a doctor’s office, clinic or hospital. It happens at home, too, and we want to support that care as well,” L.A. Care CEO John Baackes told AIS… Read more

From Radar on Specialty Pharmacy - In 2016, commercial per-member pre-month (PMPM) medical benefit pharmacy trend underwent the largest jump in five years, according to Magellan Rx Management’s Medical Pharmacy Trend Report. “Commercial PMPM trend was seven percentage points higher — 21%, a 62% difference — than the 13% average annual trend of the last five years,” said Casandra Stockman, Pharm.D., vice president of medical pharmacy strategy. Increases in drug prices were the largest contributing factor driving the… Read more

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