Almost all workers with insurance have drug coverage, according to a report by the Kaiser Family Foundation. That's 99 percent in HMOs and 100 percent in PPOs.... Pharmaceutical Research and Manufacturers of America launched a major educational campaign designed to block drug formulary plans in state programs, such as Medicaid. As a price of admission, this type of formulary often demands deep cuts in prices from drug makers.... Mounds of research generated by think tanks and foundations is often ignored by state officials, a Health Affairs study says. Policy makers are overwhelmed by what they receive and often do not read one third of it. Keep it short, the article advises. State officials prefer to get their info in small, bulleted paragraphs.
Managed Care’s Top Ten Articles of 2016
There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.
They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?
A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.
More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.