A recent study indicates that more than 60 percent of drugs were preferred on two to four of the six California formularies evaluated.

"We described how much variability there was exhibited between formularies. The more variability, the harder it is for doctors to act as agents on behalf of their patients," says William H. Shrank, MD, lead author of the study. The researchers evaluated proton-pump inhibitors, statins, calcium-channel blockers, and ACE inhibitors. None of the drugs were preferred on all formularies in 2002, and 10 percent were not available on any of the formularies.

Formulary placement status of five major drug classes
Total formularies* offering drug in ...
Agent Blue Shield Aetna HealthNet Pacificare Blue Cross Cigna 2000 2002
Proton-pump inhibitors
Rabeprazole 00/02 00/02 00/02 00/02 NP 02 4/6 5/6
Esomeprazole NP NP NP NP NP NP 0/6 0/6
Lansoprazole NP 00/02 NP NP 00/02 00/02 3/6 3/6
Omeprazole NP NP 00 NP NP NP 1/6 0/6
Pantoprazole 00/02 NP 00/02 00/02 02 02 3/6 5/6
Fluvastatin 00/02 00/02 00/02 NP 00 02 4/6 5/6
Atorvastatin 00/02 NP 00/02 NP 00/02 NP 3/6 3/6
Pravastatin 02 NP 00/02 00/02 NP 00/02 3/6 4/6
Simvastatin NP 00/02 NP 02 NP 00/02 2/6 3/6
Calcium channel blockers
Nicardipine NP 02 NP 00/02 NP 00 2/6 2/6
Isradipine NP NP NP 00/02 00/02 00/02 3/6 3/6
Amlodipine NP 00/02 00/02 00/02 00/02 NP 4/6 4/6
Felodipine 00/02 00 00/02 00/02 00/02 NP 6/6 5/6
Nisoldipine 00/02 NP 00/02 00/02 00/02 NP 4/6 4/6
ACE inhibitors
Quinapril NP 00/02 00/02 02 00/02 00/02 4/6 5/6
Ramipril NP 02 02 02 02 02 0/6 5/6
Benazepril 00/02 NP 00/02 00/02 00/02 00/02 5/6 5/6
Trandolapil NP 02 NP 02 00/02 00/02 2/6 4/6
Moexipril 00/02 NP 00/02 NP NP 02 1/6 3/6
Legend: 00, preferred in 2000; 02, preferred in 2002; NP, nonpreferred in 2000 or 2002.
*Fraction is the number of plans over the total number of plans studied

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.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

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.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
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Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

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.