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TRICARE Gears Up for Move Away From Fee-for-Service

with Chart: Current TRICARE Contracts at a Glance

October 14, 2019

The Dept. of Defense (DoD) is taking the first steps toward bringing value- based contracting to the TRICARE program — a change that could offer a lucrative opportunity for major health insurance companies that are already well-versed in executing such models.

TRICARE is the government’s health insurance program for members of the armed forces, military retirees and their dependents. Centene Corp. subsidiary Health Net Federal Services LLC currently holds a contract to cover the West TRICARE region — comprising 3.1 million beneficiaries — while Humana Military Healthcare Services Inc. controls the East region, which covers about 6.8 million beneficiaries. Both contracts were awarded in 2016 and provide five one-year options exercisable by the DoD.

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Will States, Insurers Take CMS Up on Wellness Demo Offer?

October 14, 2019

Contending that the individual insurance market should allow “health-contingent” wellness programs just like employer-based plans do, the Trump administration recently invited 10 states to test such programs in an Affordable Care Act-authorized demonstration project.

However, one expert tells AIS Health it’s unclear if many states or insurers will want to participate, given the current stability of the individual market and the stringent guardrails that federal law places on such programs.

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News Briefs

October 14, 2019

✦ Based on an early analysis of star ratings that CMS recently published for Medicare Advantage plans on the new Medicare Plan Finder, one Wall Street analyst saw “no surprise stars.” Humana Inc. and UnitedHealth Group both maintained an average 4-star-plus rating, Citi analyst Ralph Giacobbe found, while Aetna (owned by CVS Health Corp.) improved to over 4 stars. Cigna Corp. also scored above 4, while Anthem, Inc. and Centene Corp. “scored just below the threshold based on our initial analysis,” Giacobbe noted.

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Low-Cost Enhanced PDP Offerings Gain Steam in 2020

with Chart: Medicare PDP Landscape Remains Robust in 2020

October 10, 2019

When it comes to Medicare Part D stand-alone Prescription Drug Plans (PDPs) in 2020, experts say the most notable trend is the rising prevalence of lower-cost enhanced plan offerings.

According to CMS’s recently released landscape files, there will be a total of 1,433 PDP plans in 2020, up from 1,369 in 2019. Filtering out non-U.S. regions and duplicate plan offerings listed in the file, the number of PDP choices increased from 901 in 2019 to 948 next year, says Shelly Brandel, a principal and consulting actuary in the Milwaukee office of Milliman, Inc.

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CVS, Express Scripts, OptumRx Unveil 2020 Formulary Details

October 10, 2019

The largest PBMs are taking very different approaches to building their 2020 formularies, including maximizing rebates, focusing on multi-source brand exclusions and removing products that have experienced hyperinflation, benefits consultants say.

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