From AIS's Health Reform Week - Despite withering attacks from virtually all Republicans and growing concerns from some Democrats, the Obama administration remains steadfast in asserting that the health insurance exchanges will be ready for business come October. President Obama and top officials from HHS are pushing back against critics — including those in their own party — who claim efforts are lagging in the monumental effort to implement the marketplaces in all 50 states and the District of Columbia. Read more
From Health Plan Week - Early signs from rate filings for 2014 — as in Maryland, where the dominant Blues plan recently asked state regulators for a 25% premium increase compared with 2013 policies for individual plans sold on the state-based marketplace opening next year — are indications of the uncertainties about how accurate pricing will be in the initial year of the public exchanges, health insurance industry insiders say, since other carriers asked for… Read more
From Inside Health Insurance Exchanges - HHS’s decision to delay elements of the health reform law is prompting renewed speculation that the feds will push back the start of federally facilitated exchanges (FFEs). Others, however, caution that delay rumors are nothing new, and point to inaccurate predictions that the Supreme Court last June, and the presidential elections last fall, would delay or derail exchanges. In March, HHS indicated that a key feature of the Small Business Health… Read more
From Medicare Advantage News - Medicare Advantage plan sponsor Universal American Corp. is building a potentially substantial new business helping rural providers start MA plans of their own, sometimes in areas where the company itself has MA operations. Universal American will be supplying capital, taking risk and performing insurance-related functions in return for 50% of the net profits in an approach linked partly to aiding the providers as managed care business for Medicare-Medicaid dual eligibles… Read more
From Drug Benefit News - It’s been a year and a half since Pfizer Inc. lost patent protection on its blockbuster cholesterol-lowering drug Lipitor (atorvastatin) — which many contend was the last major expiration of the generics wave — and despite the manufacturer’s attempts to head off generic competition with copay coupons and other discount programs, new research estimates that the introduction of generic Lipitor has had a significant impact on utilization and costs in… Read more
From Report on Medicare Compliance - Compliance officers may grumble when they aren’t included in meetings with executives, but it’s up to them to insert themselves. Don’t wait for an invitation because you are, by definition, on the list. “Go to the meeting and bring donuts,” said attorney Brian Beard, director of compliance and ethics at McKesson Specialty Health in Houston. Similarly, consider revising the way you interact with departments, such as lab, pharmacy and radiology. Read more
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