May 2012

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COVER STORY

Two vaunted ideals of health care, experts say, should be perfectly aligned. And they almost are.

Timothy Kelley

When drug manufacturer coupons make members’ costs for brand drugs equal to generics — or less — health plans, employers, PBMs, and members pay a price

Linda Cahn

As expensive products increase their share of the medication market, expect these methods to be employed widely

Ira Studin, PhD, MPH

When 32 million or more new members, courtesy of the Accountable Care Act, are just not enough

John Carroll

Even though accountable care organizations have not lived up to their promise, some will ultimately succeed

Richard Stefanacci, DO, MGH, MBA, AGSF, CMD

PEER-REVIEWED

A review of the available research identifies payment for services in the absence of high-quality scientific evidence and presents an opportunity to use evidence-based medicine to develop a clinical coverage guideline

James P. Reichmann, MBA; Michael S. Kirkbride, BSc, Pharm D

EDITOR’S MEMO

John Marcille

LEGISLATION & REGULATION

Plans will compete for new enrollees, including people with major health problems

John Carroll

MEDICATION MANAGEMENT

Also called observational research, these studies dig down to the provider and patient level rather than analyzing only population-level data

Thomas Reinke

PLAN WATCH

Young women on Medicaid tend to skip physicals because of child care concerns. One insurer thinks it might have an answer.

Frank Diamond

TOMORROW’S MEDICINE

This screening tool is less invasive than a colonoscopy, with a specificity approaching 99 percent as risk increases

Thomas Morrow, MD

NEWS & COMMENTARY

NEWS & COMMENTARY

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