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Spending growth for specialty drugs rose 19.6% between 2009 and 2010, while growth of traditional drugs decreased by 1.4%, according to Express Scripts' 2010 Drug Specialty Report. Payers are struggling to appropriately manage high-cost drugs while ensuring their members get the care they need. One strategy is introducing a specialty drug tier to the formulary, which raises a red flag on access issues.

Most top-quality health plans in the U.S. are offered by nonprofit organizations, says Bruce McPherson, president and CEO of Alliance for Advancing Nonprofit Health Care. He bases that claim on 2011 rankings recently released by the National Committee for Quality Assurance (NCQA)

Cancer drives healthcare costs - to the tune of $124 billion on cancer drugs in 2010 alone - according to Medco, a pharmacy benefit manager. But nutritional counseling of cancer patients is often ignored, even though by some estimates most cancer patients will develop clinical malnutrition.

Nearly a third of the Medicare population is obese, which leads to more serious health problems that are expensive to treat. The Centers for Medicare & Medicaid Services (CMS) have decided to cover obesity screening and counseling as a preventative measure, but are primary care physicians equipped to provide such services?

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.

FDA’s Vaccines and Related Biologics Advisory Committee recently voted in favor of expanding the indication for the pneumococcal 13-valent conjugate vaccine (Prevnar 13) for the prevention of pneumococcal disease in adults age 50 years and older, Pfizer Inc, the drug’s manufacturer, said in a statement.

Industry experts say although it seems early for states to establish insurance exchanges, they shouldn't risk waiting too long.

When it comes to predicting geographic variations in cost, what's true for Medicare doesn't necessarily hold for the commercial populations.

While health plans might point to legislation and expansion of public programs as a hindrance, an increase in administrative services only (ASO) arrangements is taking a bite out of the business as well

The advent of ACOs will reshape healthcare delivery, however, the commercial market is positioned to drive the revolution much faster.