Healthcare Reform Blog

matt-arnold-81x99.pngContributer: Matthew Arnold
Topics: Hospitals, Pharma, MCO, PBMs, Health Plans, Health Care Marketing

As hospitals and health systems seek to control drug costs through increasingly restrictive formularies, drug companies are eager to reach the people that call the shots on what treatments are covered.
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Posted on: 7/16/2014 9:59:42 AM


Laura BeermanContributor: Laura Beerman
Topics: ACA, ACO, Payers

Remember those commercials for Hair Club for Men where the spokesperson says, “I’m not just the President; I’m also a client”? At the ExL Pharma Partnering with ACOs conference in Philly recently, I had the privilege of being both a presenter and an attendee. And in a single sentence, I can give you the key conference takeaway: Customize your strategy – by drug/device, by stakeholder and by market.
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Posted on: 6/14/2013 12:31:42 PM


Contributer: Sheri Sellmeyer
Topic: Pharma and social media

The days when pharma reps could discuss off-label uses of their companies’ drugs are a distant memory for some, and no memory at all for younger reps who entered the business after the FDA issued strict regulations on the matter.

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Posted on: 1/17/2012 12:01:48 PM


Contributor: Renee Burnham
Topic: Specialty pharma

The coming year could very well see the biggest cumulative drop in prescription drug spending in history. Contributing to that drop: the patent expirations of best-selling drugs Plavix and Lipitor, among dozens of others (PwC pegs the drop in sales in 2012 at $28.1 billion).

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Posted on: 11/9/2011 11:14:23 AM


Contributor: Roy Moore
Topic: Pharma/MCO Contracting

Every bronze medal winner knows that moving from third place to gold requires a strategy for overtaking No. 1 and 2. For Olympian Carl Lewis, improving from a bronze medal at the 1979 Pan Am games to gold at the 1984 Summer Olympics required an intense plan that increased his long jump from 8.13 meters to 8.3 meters. Sometimes gold is won or lost on the strength of those plans, and slight improvements earn you victory.

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Posted on: 4/22/2011 12:55:49 PM


Contributer: Laura Beerman
Topics: ACO, pharmacy risk, physicians

In May, I flew to San Francisco and the steward, long before he offered me my complimentary beverage and six peanuts, tried to sell me an airline credit card. I was suitably outraged at this captive sales pitch. But in the non-stop flight called ACOs, the captive pitch could be the difference between success and failure. And physicians may be doing the selling.
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Posted on: 7/23/2014 2:24:59 PM


matt-arnold-81x99.pngContributer: Matthew Arnold
Topics: Hospitals, Pharma, MCO, PBMs, Health Plans, Health Care Marketing

As hospitals and health systems seek to control drug costs through increasingly restrictive formularies, drug companies are eager to reach the people that call the shots on what treatments are covered.
Read more.
Posted on: 7/16/2014 9:59:42 AM


Jane DuboseContributor: Jane Dubose
Topic: pharmacy benefits, copay coupons

Last month, UnitedHealthcare went out on a limb with its decision to prohibit the use of copay coupons at retail settings for its commercial book of business (the coupons are not allowed for Medicaid and Medicare). Now, it appears the limb broke, and the company has essentially decided to backtrack. Read more.
Posted on: 4/15/2014 1:50:00 PM


Sheri SellmeyerContributor: Sheri Sellmeyer
Topics: Exchanges, pharmacy benefits, copay coupons

The blogosphere has lately been abuzz with an important question for pharma: Can copay coupons be used for enrollees in the new health benefit exchanges that launched this month?

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Posted on: 10/10/2013 10:00:24 AM


Laura BeermanContributor: Laura Beerman
Topics: ACA, ACO, Payers

Remember those commercials for Hair Club for Men where the spokesperson says, “I’m not just the President; I’m also a client”? At the ExL Pharma Partnering with ACOs conference in Philly recently, I had the privilege of being both a presenter and an attendee. And in a single sentence, I can give you the key conference takeaway: Customize your strategy – by drug/device, by stakeholder and by market.
Read more.
Posted on: 6/14/2013 12:31:42 PM


Chris Clancy

Contributor: Chris Clancy
Topic: Pharmacy benefits, P&T committees, value-based formularies

When it comes to assessing the clinical benefits of a drug and deciding on which tier that drug is placed, the conversation traditionally begins and ends with a plan’s Pharmacy and Therapeutics Committee. However, now that Premera Blue Cross in Washington has seen its value-based formulary implemented by a couple of large, healthcare-related employers in the Puget Sound area, a new avenue of cost savings may exist for insurers wanting more bang for their drug-purchasing buck.

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Posted on: 5/16/2013 1:41:53 PM


Jenny Kerr

Contributor: Jenny Kerr
Topic: Employers, specialty drugs, pharmacy benefits

Employers are becoming more aware of specialty pharma costs, according to a recent survey from the Midwest Business Group on Health, but they still have a lot of work to do in managing these drug benefits.

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Posted on: 2/6/2013 11:17:51 AM


Lyda PhillipsContributor: Sheri Sellmeyer
Topic: State exchanges, Medicaid, pharmacy benefits

With the health benefit exchanges less than a year away, MCOs and pharma are still mulling over how to respond in terms of pricing products, targeting clients, and gaining market share from the millions of new people who will be getting health insurance coverage in 2014.

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Posted on: 2/1/2013 5:01:46 PM


Contributor: Bill Melville
Topic: Mergers, Blue Cross Blue Shield, Pharmacy Benefit Managers

Health Care Service Corp. doesn’t grow haphazardly. In fact, the nation’s fourth-largest insurer adds new nonprofit Blue Cross and Blue Shield plans at a snail’s pace compared to for-profit insurance competitors.

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Posted on: 10/4/2012 4:35:37 PM


Contributors: Mark Cherry and Betsy Pankey-Dooley
Topic: ACOs, Pharmacy Benefit, Medicare

Talk to any Medicare ACO about drugs and you will hear a lot about medication adherence. They have care coordinators standing by to nudge members into taking their prescribed drugs, and will be supported by CMS claims data to see when scripts are refilled and picked up. They will use this claims data along with consultation to avoid duplication and bad interactions. Better to manage a senior’s medication now than to need a trip to the ER later, the thinking goes.
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Posted on: 8/1/2012 2:22:10 PM


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