Preferred pharmacy plans in Medicare Part D increasingly popular | GAO: ACA tax credits expanded access to health insurance | Medicare SGR fix could come at Medicaid's expense
March 24, 2015
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Preferred pharmacy plans in Medicare Part D increasingly popular
Most Medicare beneficiaries in a standalone prescription drug plan have chosen a preferred network plan offering lower premiums and out-of-pocket expenses, a Drug Channels Institute analysis found. "Preferred networks force pharmacies to compete for the business of the payer, and they compete by reducing their profits," institute CEO Adam Fein said. Medicare beneficiaries in a Part D prescription drug plan overwhelmingly have chosen plans featuring preferred pharmacies that offer lower premiums and out-of-pocket expenses. A PCMA-released study by Oliver Wyman concluded that eliminating these popular plans would increase annual premiums by approximately $63 for more than 75% of Part D beneficiaries and increase program costs by $24 billion over a decade. Managed Care magazine (3/2015)
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Legislative & Regulatory News
GAO: ACA tax credits expanded access to health insurance
The Affordable Care Act's tax credits lowered monthly health insurance premiums for subscribers and led to expanded coverage last year among households eligible for the credits, according to the Government Accountability Office. However, health care costs could affect insurance affordability in the future, the GAO said. Reuters (3/23)
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Medicare SGR fix could come at Medicaid's expense
Senior House Republicans are considering cuts to Medicaid to partially offset the cost of revising the formula under which Medicare reimburses doctors, according to officials familiar with the discussions. The Washington Post (tiered subscription model)/The Associated Press (3/24)
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Health insurance enrollment likely to slow, analysts say
The pace at which the nation's uninsured rate is falling is likely to slow now that the most highly motivated uninsured have gained coverage, some analysts say. The slower increase could be due to continued misunderstandings and low awareness about how the Affordable Care Act works, and because penalties for remaining uninsured are comparatively low, analysts say. The New York Times (tiered subscription model)/The Upshot blog (3/23)
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HHS: Hospitals saved $7.4B under ACA in 2014
In 2014, hospitals had $7.4 billion less in uncompensated costs than in 2013 as patients gained insurance under the Affordable Care Act and the number of emergency room visits declined, according to data released by HHS. Washington, D.C., and the 28 states that expanded Medicaid eligibility saved $5 billion, while states that did not expand the program saved $2.4 billion. Reuters (3/23), The Hill (3/23)
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Bill to expand Mont. Medicaid hits roadblock in Senate panel
Montana state senators added amendments to a bill that would expand Medicaid eligibility under the Affordable Care Act, stalling the bill's passage through the Senate Public Health Committee. If the Legislature does not pass an expansion bill by the end of March, it is not likely to do so this year. Independent Record (Helena, Mont.) (3/24)
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Report shows cost efficiency of switching to electronic transactions
A CAQH report revealed that the health care industry could save $8 billion every year by converting manual business transactions, such as claims submission and benefit verification, to electronic transactions. The estimated cost for providers per electronic transaction is $1.60, compared with over $5 for a manual transaction, the report said. (3/23)
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Drug Industry Spotlight
Analysis shows $1B sales potential for Bristol-Myers, Sanofi, Novartis drugs
Bristol-Myers Squibb's Opdivo, Sanofi's Praluent and Novartis' drug LCZ-696 have the potential to become blockbusters with more than $1 billion in yearly sales, a Thomson Reuters analysis says. In 2019, sales for Bristol-Myers' cancer drug may reach $5.7 billion, Sanofi's cholesterol drug could hit $4.4 billion in sales, and Novartis' heart failure treatment, which could receive FDA approval in August, may see sales of $3.7 billion. Reuters (3/23)
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Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time."
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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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