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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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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Contributor: 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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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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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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Contributor: Chris Lewis
Topic: Pharmacy Benefits

How could the biggest pharmacy benefit manager in the country continue to exclude the nation’s biggest drug store chain from its network? As a former Walgreens customer, I was dismayed at first, but then I got over it and went on with my life. I had choices.
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Contributor: Betsy Dooley
Topic: Exchanges, Pharmacy Benefits, Medicaid

The multibillion-dollar question for the pharma industry is what kind of prescription drug coverage will be offered under the state exchanges. For states with strong Medicaid MCOs, all signs point toward aligning benefits more with the state’s Medicaid model than with Medicare or commercial benefits. The strongest rationale is that it would help with continuity of coverage for people dropping off Medicaid and going into an exchange plan or vice versa.

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Contributor: Ric Gross
Topic: Pharmacy benefits, Couponing

Massachusetts often prides itself on being a maverick. After all, the state implemented near-universal healthcare reform in 2006, when no other state was even considering such a move. At the same time, it enforced an individual mandate, now quite the catch phrase, but relatively unheard of at the time. And it took a hard stance against pharmaceutical companies, being the only state to maintain a circa-1988 law which prohibited the use prescription drug coupons. However, with a stroke of Gov. Deval Patrick’s pen, that domino has now fallen.
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Contributer: Bill Melville
Topic: Pharmacy Benefits

In the PBM world, the glare of the planned Medco-Express Scripts merger can be blinding. Beyond it, there are developments worth watching. Several smaller operators are making crafty partnerships to build market share.
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Contributor: Laura Beerman
Topic: Pharmacists

When more people have access to healthcare coverage in 2014, the existing shortage of physicians could make a good doctor even harder to find. Waiting in the wings are other practitioners—including pharmacists—who can provide effective, patient-centered care.

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