December

EmblemHealth Continues Losses, Settles Breach, Underpayment Suits

with Chart: EmblemHealth Saw Net Loss Swell in Third Quarter

December 31, 2018

Troubled EmblemHealth Inc., one of the nation’s largest nonprofit health insurers, continues to struggle with its turnaround plans: Over the past two months, the company posted losses in its two largest subsidiaries for the first three quarters of 2018. It also settled three legal claims, paying civil penalties for a privacy breach and for failure to properly cover gender reassignment surgery, plus agreeing to an undisclosed settlement in a whistleblowers’ suit.

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N.C. Blues Product May Save Money, but Holds Major Pitfalls for Members

December 31, 2018

A new individual and small-group product from Blue Cross and Blue Shield of North Carolina that reimburses members directly for care at a flat 140% of Medicare rates could be one answer to the problem of how to hold policy costs down, some analysts say. But others warn that members may be unprepared for negotiating fees, especially for more complex care scenarios, and may be caught off guard by balance bills.

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Coming OEP Has MA, Part D Plans Focused on Happy Members

December 31, 2018

As Medicare Advantage and Part D sponsors compete for enrollees during the 2019 Annual Election Period (AEP) that began on Oct. 15 and ends on Dec. 7, a major focus this year is the newly reinstated Open Enrollment Period (OEP) during which beneficiaries have a chance to switch plans. While this means possible membership losses for some plans, a prohibition on targeted marketing during the OEP has insurers doing everything they can to ensure smooth member interactions for maximum retention and acquisition of new enrollees, marketing experts tell AIS Health.

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PBMs May Be Able to Handle Pressure From Medicaid Programs

December 28, 2018

As states take a hard look at how they can reduce prescription drugs spending in their Medicaid programs, they’ve put an already heavily scrutinized type of organization in their crosshairs: PBMs.

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New Hep C Approach Might Not Save Money, PBM Execs Warn

with Chart: Current Market Access to Hepatitis C Medications

December 28, 2018

A small study suggests it might be possible to shorten the length of expensive drug treatment for chronic hepatitis C virus (HCV), potentially cutting treatment time in half for 50% of patients. But managed care pharmacy clinicians say the results are far from ready to implement widely, and it’s possible the new approach might not even save money.

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Judge OKs CVS Plan to Keep Aetna Separate Pending Review

December 28, 2018

Facing an unexpected judicial roadblock in the plan to combine their two businesses, CVS Health Corp. and Aetna Inc. successfully negotiated a deal to keep their PBM and health insurance operations separate for at least the next few months.

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