August 2009

Features

Cover Story

Value-Based Insurance Design: Spend a Little More On Selected Patients For Payoff Down the Line
Plans and payers are looking at a new insurance design that puts quality first. It might also save money.
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Use a Value-Based Strategy for Biotech Medications
Coverage often straddles the line between the pharmacy and medical benefit, but a properly constructed formulary can bridge the gap
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Inventive Approaches Curtail Imaging Costs
Radiology benefit management programs and the launch of new guidelines may slow utilization
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Control Specialty Drug Cost By Making Your PBM Helpful
Unfortunately, most contracts practically invite the companies that health plans deal with to manipulate prices
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Q&A

A Conversation with the Dartmouth Atlas Project’s Elliott Fisher, MD, MPH
We need to reduce unwarranted geographical variations in care
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Health Care Reform Push Pits States Against Feds
A ‘health insurance czar’ might not make the final bill, if there is one, but the proposal evokes centuries-old tension
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Part D in Crosshairs for 2009
Legislators are looking closely at ways to prevent fraud and enforce new marketing and educational regulations
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Departments

Employers, Insurers Expect More for Money
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Letters to the Editor
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Medicare Helps PCPs at Specialists’ Expense
Just who gets paid for what — and how much — is expected to change in a big way in 2010
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Copycat Biopharmaceuticals Would Not Guarantee Savings
The FTC warns that the competition between ‘follow-on’ biologics and the pioneer products is likely to be of the brand-vs.-brand variety
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Pharmacist employment outlook rosy
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PDPs see increases in cost-sharing amounts
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Prasugrel, New Platelet Inhibitor, Subject of Formulary Debates
This competitor of clopidogrel will probably be most useful for patients in the initial phases of acute coronary syndrome
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Florida Blue Tells Folks To Step Right In, Feel at Home
Retail stores offer “young invincibles” and the working poor the chance to examine low-cost coverage options
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Rising rates bring focus on self-insured plans
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News

Government Raises Red Flags Over Ultrasound Use Variations    DIGITAL | HTML

Medicare Advantage beneficiaries enroll in only a few plans    DIGITAL | HTML