November

Rebate Rule Rises From Dead, but Could Still Be Doomed

November 30, 2020

On Nov. 20, HHS finalized a once-tabled regulation that would revamp the Medicare prescription drug rebate system. While that may seem to be unwelcome news to the health insurers and PBMs that have vocally opposed the so-called rebate rule, it is not at all certain that this version will survive amid likely legal challenges and the upcoming transfer of power in the White House.

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For PBMs, Amazon Pharmacy May Be Both Friend and Foe

November 30, 2020

Amazon.com, Inc. made a splash in the health care world on Nov. 17 when the online retail powerhouse unveiled new pharmacy offerings that aim to disrupt the prescription drug market with increased convenience and savings. Industry analysts tell AIS Health that the competitive threat to major PBMs is likely to be minimal, as those firms have certain advantages and capabilities that Amazon won’t easily be able to match.

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Insurers Prepare to Pay For, Help Distribute COVID Vaccine

With Chart: Coronavirus Vaccine Effort Gets Closer to Finish Line

November 30, 2020

As details continue to emerge about the availability of COVID-19 vaccines and how they will be administered, the role that payers will play in the process is becoming clearer.

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News Briefs

November 30, 2020

✦ Prime Therapeutics LLC, the PBM co-owned by 18 Blue Cross and Blue Shield plans, hired a new data analytics executive team. The new hires include Urvi Randhar as senior vice president and chief information and technology officer, Sam Mohanty as vice president and chief data officer, and Sarah Taylor as vice president and chief analytics officer. Randhar was most recently vice president of digital products at Healogics Inc., while Mohanty previously worked at United Airlines Inc. and CVS Health Corp., and Taylor formerly held roles at UnitedHealthcare, UCare Minnesota Inc. and Medica Corp. Read more at https://bit.ly/376pKDn.

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Insurers Sound Alarm Over Increasingly Pricey COVID-19 Tests

November 25, 2020

With the COVID-19 pandemic getting worse than ever, health insurers are facing an uncertain level of exposure to testing costs. That’s because payers and plan sponsors are on the hook for the entire cost of coronavirus tests — which can vary widely — and they could be required to pay for even more testing depending on the strategy that the Biden administration plans to pursue.

The Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security (CARES) Act require plan sponsors to pay all in- and out-of-network claims for diagnostic and antibody testing services. The CARES Act says those claims must be paid at a listed “cash price,” which essentially allows labs to name a price for test processing.

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States Look Beyond Reinsurance to Protect Individual Markets

November 25, 2020

Reinsurance programs can help lower premiums in the individual insurance market, but they’re not enough by themselves — states will need to experiment with broader measures to impact underlying health care costs, particularly for unsubsidized individual market enrollees, a report from The Commonwealth Fund concludes.

However, such programs could be a tough sell as states tighten their budgets because of the COVID-19 pandemic, says study author Justin Giovannelli, an associate research professor and project director at Georgetown University’s Center on Health Insurance Reforms.

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