Industry Analysis

Prime Therapeutics (Prime) will administer pharmacy benefits for Blue Cross and Blue Shield of North Carolina (BCBSNC) commercial customers staring in April next year. The companies say the move will result in lower pharmacy costs for BCBSNC customers and more flexibility regarding services and programs.

The Archon Genomics X PRIZE presented by Medco will measure teams on accuracy, cost, speed and completeness of genome sequencing. The goal is to push the industry to develop, more accurate, faster and more cost effective sequencing technologies.

Two University of Michigan (UM) developed healthcare initiatives were recommended to the U.S. Secretary of Health and Human Services in an Institute of Medicine report about the future of the nation’s healthcare.

Medicare Advantage plans may have a difficult time attaining four- and five-star ratings under the Centers for Medicare & Medicaid Services’ (CMS) Five-Star Quality Rating System if they don’t keep up with the system’s changes.

The Obama administration has moved one step closer to defining the healthcare services insurers will have to offer in exchanges.

Enrollment in Medicare Advantage plans climbed this year, despite the fact that payment rates were frozen

The biggest challenge health insurers face each year is convincing members to get their flu shots.

Blue Shield California will no longer pay for the use of Avastin to treat metastatic breast cancer.

Cigna recognizes potential of Medicare Advantage market

A wave of consolidation among providers is being blamed for driving up costs.

Large health plans across the country are diving into accountable care with some degree of success.

Four-tier formularies have emerged as one method to control the rising costs associated with specialty pharmaceuticals.

The National Association of Boards of Pharmacy has developed a platform for sharing prescription monitoring programs

Insurers must invent new healthcare solutions to be competitive in the market emerging under the Patient Protection and Affordable Care Act, according to a new report.

Edith Rosato will take over for long-time CEO Judith Cahill, who announced retirement plans earlier this year.

Private insurers might need to offer parallel incentives for the accountable care organization model to have critical mass in paying for quality

Evaluate technology devices that your members use to determine the best ways to reach them with health outreach, enrollment, hot transfer and care coordination

Private fee-for-service plans are under scruntiny as perhaps being partly responsible for skyrocketing Medicare expenditures.

Rethink benefit options and watch for new consolidations in your local provider market

Providers, plans and pharma companies promise to produce savings through tried and true methods, but skeptics doubt they'll make any sacrifices

United says it has no plans to follow suit by selling off its pharmacy benefit services. WellPoint will oursource now.

Employers' dependent eligibility audits find 5% don't belong on the plan. Next step is voluntary opt-out followed by removal.

Policy makers focus on consumer protection and health plan conduct

Washington, D.C.-National healthcare spending rose 6.7% in 2006 to $2.1 trillion, just slightly faster than the previous year but still fairly stable. Overall, outlays for healthcare reflected a continued slowdown from the double-digit growth rates of the 1990s. Payments for most major health services-hospitals, physicians, nursing homes, home health services-experienced slower growth than 2005.

A national examination of disease prevalence among Medicaid beneficiaries underscores ways that managed care plans can rethink care management approaches for high-need, high-cost beneficiaries with multiple chronic conditions.