Most Clicked PCMA SmartBrief Stories
1. 67% increase in specialty drug market expected, Express Scripts finds
PCMA SmartBrief | May 22, 2013
Express Scripts projects that spending on specialty treatments is likely to grow by 67% by the end of 2015. The specialty drug market will be worth almost $115 billion in the U.S. next year, according to the report. KMOX-AM (St. Louis) (05/21) Drug Store News (05/21) American City Business Journals (05/21)
2. CMS finalizes MLR rules for supplemental Medicare plans
PCMA SmartBrief | May 20, 2013
Medicare Advantage and Part D prescription drug plans must spend 85 cents of each premium dollar on direct patient care under final rules to be published May 23. Bloomberg BNA (subscription required) (05/17)
3. Move to value-based reimbursement a day of reckoning for pharma
PCMA SmartBrief | May 22, 2013
Drugmakers are less prepared for the transition to value-based reimbursement than other parts of the health care sector, Daniel R. Hoffman writes. Payments to health care providers will be based on patient outcomes produced by their practice patterns. Hoffman says patients will be hit with a greater share of expenses as insurers shift costs to them, and he expects U.S. consumers to react against drug price discrepancies between the U.S. and Europe. Philly.com (Philadelphia) (05/21)
4. Cost-saving preferred pharmacy model likely to catch on
PCMA SmartBrief | May 23, 2013
As states consider drug formularies for insurance plans sold via Affordable Care Act exchanges, more are likely to turn to preferred pharmacy models to save money, says PCMA President and CEO Mark Merritt. "The era of preferred pharmacy networks is something we're on the very, very front end of," Merritt said. "There is enormous potential to save millions of dollars with more efficient pharmacy networks in the exchanges." AIS Health (05/22)
5. Companies embrace bare-bones plans for affordable ACA compliance
PCMA SmartBrief | May 20, 2013
Some employers have turned to health plans that offer minimal coverage in an effort to comply with the Affordable Care Act and avoid paying tax penalties. Advisers and brokers are increasingly promoting the plans, which do not cover certain services such as hospital or prenatal care, and are also offering small employers self-insurance options, which are subject to fewer ACA rules than conventional plans. Wall Street Journal, The (05/20)
6. Seniors like Part D preferred pharmacy networks, survey finds
PCMA SmartBrief | May 21, 2013
Among seniors enrolled in preferred-network Medicare Part D plans, 85% said they are satisfied, 81% said the pharmacies in the network are convenient and 80% would not be pleased if the plan were eliminated, according to a Hart Research Associates survey. Drug Store News (05/20) Hill, The (05/20) Chain Drug Review (05/20)
7. CMS approves Va. dual-eligibles program
PCMA SmartBrief | May 22, 2013
Virginia received federal permission to implement a four-year pilot program consolidating services for people eligible for both Medicare and Medicaid. Washington Post, The (05/21)
8. 3 insurers to sit out first year of Calif. exchange
PCMA SmartBrief | May 23, 2013
Los Angeles Times (tiered subscription model) (05/22)
9. PBMs offer solutions for N.C. budget woes
PCMA SmartBrief | May 21, 2013
North Carolina could reduce spending by modernizing its Medicaid pharmacy benefit, a Menges Group study found. "The good news is state Medicaid programs can dramatically reduce costs by simply applying best practices already used by Medicare and other large payers that offer pharmacy benefits," PCMA President and CEO Mark Merritt said in a statement. Spending by North Carolina's Medicaid program exceeded the budget by hundreds of millions of dollars for three years in a row, according to the state auditor. American City Business Journals (05/20)
10. Calif. exchange takes shape with 13 insurers, rate estimates
PCMA SmartBrief | May 24, 2013
Preliminary rate information suggests individuals who buy health coverage through the Covered California exchange will pay about what small businesses do. Thirteen insurers will sell through the state's exchange, officials said Thursday. New York Times (tiered subscription model), The (05/23)
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