November

New Migraine Drugs Could Spark Value-Based Contracting

with Chart: Current Market Access to Migraine Medications

November 26, 2018

Therapy for chronic migraine — a condition that’s been notoriously difficult-to-treat and which often leads to significant direct and indirect health care costs — has been upended with the recent approval of three injectable monoclonal antibody products in a new preventive medication class that’s significantly more effective than older preventive migraine drugs, a researcher says.

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To Manage Orphan Drug Spend, Look to Data to Identify Outliers

November 26, 2018

Orphan drugs are a fast-growing component of health plans’ drug spend, and controlling utilization while ensuring appropriate patients have access requires plans to put in place a multi-pronged strategy that encompasses site-of-service interventions, provider education and innovative contracting, experts say.

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Equity Analysts Underscore Solid MCO Fundamentals

November 26, 2018

At a recent roundtable in Washington, D.C., Wall Street analysts posited that vertical integration among insurers, PBMs and retail pharmacies is likely to reap rewards, managed care organizations must enhance their work with large employers, and more insurers likely will sell short-term insurance products. The analysts expect MCOs will continue to focus on Medicare — and also on Medicaid managed care, well beyond the program’s potential expansion opportunities.

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News Briefs

November 26, 2018

✦ In an interview with the Wichita Eagle, Kansas Gov.-elect Laura Kelly (D) said she has a task force developing her Medicaid expansion proposal and said she expects the state’s legislature to address the issue in the next year. Kansas lawmakers approved Medicaid expansion in 2017, but then-Gov. Sam Brownback (R) vetoed it, the article noted. Meanwhile, roughly a dozen states have expressed interest in allowing people who currently aren’t eligible for Medicaid to buy into the program, Axios reported. Read the Wichita Eagle article at https://bit.ly/2OTmGzh and the Axios piece at https://bit.ly/2DxyZzf.

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Mercer’s Employer-Sponsored Health Plans Survey Shows Moderate Health Benefit Cost Growth in 2018

November 26, 2018

by Jinghong Chen

Nationwide, the average total health benefit cost per employee climbed 3.6% in 2018, up from a 2.6% increase in 2017, according to Mercer’s 2018 National Survey of Employer-Sponsored Health Plans, released Oct. 30. Smaller employers with 10 to 499 employees faced higher cost increases, averaging 5.4%. A third of covered employees are currently enrolled in account-based consumer-directed health plans (CDHPs). Looking ahead, midsized and large employers identified “managing high-cost claimants” and “creating a culture of health” as the top priorities for the next five years.

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New Biosimilars Help Crohn’s Cost, but Boost Oversight Needs

with Chart: Current Market Access to Crohn’s Disease Medications

November 20, 2018

New biosimilars for Janssen Biotech, Inc.’s Remicade (infliximab) have helped to moderate costs for Crohn’s disease as they’ve launched over the last two years, but plans still rely on utilization management strategies, including site-of-service programs, to keep the cost of treating the condition under control, experts say.

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