Pharmacy

Hundreds of private insurers are marketing Medicare Advantage plans and state-wide PPOs with unexpectedly low prices for expanded drug coverage to gain a bigger slice of the radically changing Medicare pie. While the public has been focused on deciphering new prescription drug coverage options through stand-alone prescription drug plans (PDPs), Medicare officials also note an "enormous rise in MA plans with Part D benefits," reports Medicare Senior Advisor Abby Block. More than 5 million seniors now belong to MA plans, and the number is growing monthly.

The WellPoint Inc. and WellChoice Inc. deal is further proof that merger mania among major health insurers is alive and well.

We all seem to be taking a wait-and-see approach.

When a crisis strikes, all involved should have a plan to follow

Specialty pharmaceutical spending continues to grow at almost 20% per year and more aggressive payer organizations are applying tighter controls on utilization and access to keep costs in check, according to industry experts.

Read more about management strategy.

Specialty pharmaceutical drug coverage by managed care plans

No wonder metabolic syndrome is called syndrome X. Instead of being recognized as a separate disease, it is considered a constellation of many conditions. "The biggest problem is a failure to address the underlying problem—insulin resistance," says Robert Epstein, MD, chief medical officer for Medco Health Solutions in Franklin Lakes, N.J. He calls metabolic syndrome one of the country's top five health problems.

In a case that likely will be appealed, a San Antonio jury recently awarded $7.4 million in actual damages resulting from the alleged negligence by a health maintenance organization and several providers. In the lawsuit, a deceased woman's family accused Humana, two physicians, and a physician practice group of negligence in a wrongful death action. The jury decision resulted from a three-week trial presided over by a Republican-appointed judge with an insurance defense background. In accordance with Texas law requiring the apportionment of liability, the jury found Humana liable for 35% of the actual damages and the entire $1.6 million in punitive damages.

National Reports—Health plans continue to modify medical and pharmacy benefit policies to serve members affected in the Gulf Coast region. Those adjustments range from allowing those members to have access to any provider, even if that provider is out-of-network, to suspending pharmacy restrictions on medication refills.

Last Month brought us news of the indescribable aftermath of Hurricane Katrina. I consumed all the information I could find at first, but then, like many Americans, I had to step away from the media for a while. I had to let the reality sink in without the narration of a news anchor.

New pharmacy systems are emerging that allow for deeper analysis

The 2006 introduction of Part D under the Medicare Modernization Act will definitely affect medications targeting osteoporosis, the majority of which are prescribed to those 65 or older.

Coinsurance is a valid tool for using financial incentives to help patients focus on selecting less costly therapies.

Mild to moderate psoriasis is generally treated first with topical corticosteroids and other topical remedies. When the disease is widespread or unresponsive to topical agents, ultraviolet phototherapy may be used at home or in the physician's office.

The biggest bang for the buck is treating the older population for which fractures are more prevalent.

Competition Is heating up among insurers, pharmacy benefit managers (PBMs) and health plans as they ready major marketing campaigns to attract and enroll thousands of seniors in Part D Medicare prescription drug plans (PDPs). Insurers are offering hundreds of stand-alone and Medicare Advantage prescription drug plans (MA-PDs) in every region of the country, many promoting lower costs as a way to build market share.

Critics contend that DTC promotion boosts medical costs.

August DTR Analysis.

A few months ago, Medicare officials were worried that insurers and health plans might be reluctant to offer new PPO and prescription drug coverage options created by Medicare reform legislation. Now it looks like the agency's real problem is to help Medicare beneficiaries choose wisely among a multitude of coverage options.

Prior authorization has evolved into a more-efficient process.

HMO pharmacy copay comparison

July DTR Analysis

HMO pharmacy copay comparison

One plan puts Web power to work and reduces call center volume