Trends for prescription drug coverage will slow down in 2006 to levels that are closer to those of medical coverage, according to the Segal Co., a human resources consultant.

"Trend" refers to the increase in health plans' per capita claims cost as determined by insurance carriers, managed care organizations, and third-party administrators. Trend is affected by factors such as price inflation and cost-shifting.

But lest we celebrate too quickly, the report also predicts that plan sponsors that provide PPOs, POS plans, and HMOs will experience cost increases of about 12 percent in 2006. Nearly 80 percent of respondents project costs for PPOs to increase between 10 and 14 percent.

More than half of respondents reported retail prescription drug trends for 2006 in the range of 10 to 14.9 percent — a major increase from 2005 when just 37 percent of respondents were in that range.

Trend ranges for PPOs and retail prescription drug carve-out coverage: 2003–2006

Source: 2006 Segal Health Plan Cost Trend Survey, The Segal Company
Note: PPO trends do not include prescription drug trend as a component of overall trend.

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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.

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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.