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Vol. 17, No. 4
April 2008

Cover Story

Mental Health Parity at Last?
A coalition of health plans, employers, legislators, and consumer advocates is bringing equal coverage closer to reality than it has ever been.

Forging a Better Cancer Policy
Health plans say that 20 percent of treatment costs can be eliminated, but oncologists are a hard sell.

Get Tough With Your PBM!
It starts with the language in the PBM contract and the request-for-proposals process. An experienced negotiator is your guide.

Could a Wal-Mart PBM Succeed?
The world’s largest retailer is putting one giant-sized toe in the waters of the pharmaceutical benefit management business.

Q&A: Bruce Bagley, MD, Urges Straight Talk
This American Academy of Family Physicians official wants doctors to get serious about quality improvement.

Managed Medicaid: A Good Place to Be
As rolls grow, states turn to health insurers for assistance, and many kinds of companies are now involved.

An Options Market for Health Care?
You, your employer, or your doctor would buy options guaranteeing the price of services you might eventually need.

Departments

Editor’s Memo
Will parity really make it this time?

Legislation & Regulation
Procecutor says UCR isn’t that at all.

News and Commentary
Consumer-Directed Plans See Bump in Enrollment
Medicare Advantage Marketing Slammed
Little change in overall rate of medical and pharmacy cost increases (chart)
Headlines on Deadline

Compensation Monitor
P4P programs too diverse?

Formulary Files
Consumers: We can’t afford Rx.

Medication Management
Making the most of OTCs.

Tomorrow’s Medicine
One physician can make a difference.

Outlook
“Boomers” enter Medicare.

Continuing Education Credit

Biologic Therapy Management: The Need For Value-Based Health Benefits Models

With the emergence of biologic therapies to treat chronic diseases, new models of health insurance and health care financing are needed. Personalized medicine adds yet another dimension of complexity to the challenges that managed care decision makers face. For patients, biologics offer improved quality of life and life-saving options. The higher cost of biologics presents affordability issues that employers must address if they are to continue to offer health benefits to their workers and their dependents. This special supplement presents a peer-reviewed white paper by The Biologic Finance and Access Council that forms the framework for BFAC’s fully integrated approach to resolving difficult health care financing and benefit design issues. BFAC comprises thought leaders from large employers, national and regional health plans, and pharmacy benefit managers, as well as nationally known health economists, actuaries, consultants, clinicians, patient advocates, and academicians.

Highlights:
  • Principles of Health Insurance
  • Perspectives on the Value of Biologics
  • Affordability and Access
  • Efficiencies in Management and Administration of Biologics
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