HCV drugs expected to drive up Medicare spending | New Milliman study: Hepatitis C drugs could increase Medicare Part D spending by $2.9 billion to $5.8 billion in 2015 | Read the study
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August 13, 2014
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HCV drugs expected to drive up Medicare spending
Increasing use of expensive specialty drugs could drive up Medicare costs, with spending on new hepatitis C drugs alone forecast to increase taxpayers' costs for Medicare Part D by $2.9 billion to $5.8 billion in 2015, a Milliman study found. Managed Healthcare Executive (8/12)
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Medical groups update hepatitis C treatment guidelines
The Infectious Diseases Society of America, the American Association for the Study of Liver Disease and the International Antiviral Society-USA have expanded guidelines for the care of patients with hepatitis C. A new section called "When and in Whom to Initiate HCV Therapy" addresses the identification of patients in need of urgent care, including those with advanced fibrosis or cirrhosis. "We can't possibly treat all three to four million people with this disease in the U.S., so we have to make some decisions about who to treat," said the AASLD's Dr. Donald Jensen. Healio (free registration)/HCV Next (8/11)
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Legislative & Regulatory News
Employers seek plans with preferred networks that perform
One effect of the Affordable Care Act has been to make employers and employees more attuned to health care costs and quality, says Dr. Robert Galvin, CEO at benefits advisory firm Equity Healthcare. Preferred networks have gained traction as a cost-saving tool, and network performance is becoming a primary consideration in employer choice of network, Galvin says. Companies are also giving employees access to health coaches, who can help them make informed decisions, Galvin says. Kaiser Health News (8/13)
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Study: 340B needs clearer direction from regulators
A Rand Corp. report says the 340B drug discount program needs clearer policies on transparency and eligibility due to "increasingly divergent views on the program's purpose and the role it should play in supporting safety net providers." The Health Resources and Services Administration is in the process of updating the program's rules. The Hill (8/12)
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Many states offer employees rich health benefits, study finds
States spent an average of $808 monthly per employee on health insurance last year, collectively spending $31 billion, according to a study by Pew Charitable Trusts and actuarial firm Milliman. Employees paid an average of $155 per month for the plans, most of which were equivalent to the highest-level, or platinum, health plans sold through publicly run marketplaces. The Washington Post (tiered subscription model)/GovBeat blog (8/12)
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Hundreds of thousands face loss of health coverage over immigration status
As many as 310,000 people who signed up for health insurance through the federal marketplace have until Sept. 5 to provide additional documentation showing they are U.S. citizens or legal residents. If they don't, they will lose their coverage Sept. 30. The CMS has sent letters to the affected enrollees and will attempt to contact them by phone and e-mail. The Wall Street Journal (tiered subscription model) (8/12), The New York Times (tiered subscription model) (8/13)
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Judge allows challenge to ACA tax credits to proceed
A U.S. District Court judge in Indianapolis said a lawsuit may proceed against the Internal Revenue Service for extending tax credits under the Affordable Care Act to consumers who purchased a health plan through the federally run exchange. The lawsuit contends that only consumers who bought a plan through a state-run exchange are eligible for tax credits. The suit was brought by Indiana and 39 state public school systems. Bloomberg (8/13)
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PBM Industry News
WellPoint rebrands as Anthem
Health insurer WellPoint will change its name to Anthem, the brand under which most of the company's plans are sold on the 14 public exchanges in which it participates. The move comes as the nation's second-largest health insurance carrier increasingly deals directly with consumers, the company's CEO said. The Wall Street Journal (tiered subscription model) (8/12), Bloomberg (8/13)
Drug Industry Spotlight
Lawmaker urges FDA to act on apparent shortage of Lyme antibiotic
Sen. Charles Schumer, D-N.Y., said at a news conference Tuesday that he has asked the FDA by phone and letter to address a shortage of the Lyme disease drug doxycycline. Schumer said he was told about the shortage by the American Society of Health-System Pharmacists, but the FDA says the 14 companies that manufacture the drug report there is a good supply. Schumer said a possible next move could be to draft a bill revising how drug shortages are handled and reported. Poughkeepsie Journal (N.Y.) (8/12)
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The mind is not a vessel to be filled but a fire to be kindled."
-- Plutarch,
Greek historian
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About PCMA
PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 216 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D. PCMA is dedicated to enhancing the proven tools and techniques pioneered by PBMs that generate savings and access for consumers and payors.

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