August 2009

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.

Martin Sipkoff

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

F. Randy Vogenberg, RPh, PhD

Inventive Approaches Curtail Imaging Costs
Radiology benefit management programs and the launch of new guidelines may slow utilization

Lola Butcher

Control Specialty Drug Cost By Making Your PBM Helpful
Unfortunately, most contracts practically invite the companies that health plans deal with to manipulate prices

Linda Cahn

Q&A

A Conversation with the Dartmouth Atlas Project’s Elliott Fisher, MD, MPH: National Data, National Impact
We need to reduce unwarranted geographical variations in care

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

Frank Diamond

Part D in Crosshairs for 2009
Legislators are looking closely at ways to prevent fraud and enforce new marketing and educational regulations

John Liethen<br/> and Jonathan Bakewicz

Editor’s Memo

Employers, Insurers Expect More for Money

John Marcille

Letters

Letters to the Editor
Legislation & Regulation

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

John Carroll

Medication Management

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

Martin Sipkoff

Compensation Monitor

Pharmacist employment outlook rosy
The Formulary Files

PDPs see increases in cost-sharing amounts
Tomorrow’s Medicine

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

Thomas Morrow, MD

Plan Watch

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

Frank Diamond

Managed Care Outlook

Rising rates bring focus on self-insured plans



News & Commentary

Medicare Advantage beneficiaries enroll in only a few plans

Government Raises Red Flags Over Ultrasound Use Variations