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‘Monumental’ Rebate Proposal Sparks Ire From Payers, PBMs

February 11, 2019

While a new federal proposal to overhaul the prescription drug rebate system may not be a significant threat to major managed care companies’ bottom lines, insurers and PBMs alike are still not happy about it. Industry experts say that’s because insurers will likely have to raise Medicare Part D premiums in response, thus hurting their competitive advantage, and PBMs will be forced to rework their business models.

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Centene CEO Says His Faith in ACA Exchanges Hasn’t Faltered

February 11, 2019

Even as some recent headlines have reignited concerns about the long-term prospects of the Affordable Care Act (ACA), the CEO of one of the health insurers that has benefited most from the law told investors that he continues to see more reasons to be optimistic than not.

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CMS Suggests Modest Rate Hike for MA Plans in 2020

February 11, 2019

CMS’s recent release of preliminary 2020 rate and policy information for Medicare plans indicates no major new policy proposals, and the agency’s proposed rate hike for plans seems neither excessively high nor worrisomely low, industry consultants and Wall Street analysts say.

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North Carolina Awards Much-Anticipated Managed Medicaid Contracts

February 11, 2019

by Carina Belles North Carolina this week awarded Medicaid contracts worth an estimated $6 billion per year to five managed care organizations: AmeriHealth Caritas; Blue Cross and Blue Shield of North Carolina; Carolina Complete Health, a provider-led subsidiary of Centene Corp.; UnitedHealthcare; and WellCare Health Plans, Inc. Centene was awarded a regional contract, and can […]

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News Briefs

February 11, 2019

✦ Cigna Corp. said Feb. 7 that its transition to value-based health care resulted in more than $600 million in medical cost savings from 2013 through 2017. The company said it exceeded its goal of having 50% of Medicare and commercial health care provider payments made through alternative payment arrangements in its top 40 U.S. markets by the end of 2018. Currently, 3.6 million-plus Cigna commercial customers access value-based care through more than 240 primary care provider organizations, 500 hospital facilities and 270 specialist programs in six disciplines. In addition, 85% of its Medicare Advantage members access care through value-based arrangements.

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