The AIS Guide to Blue Cross and Blue Shield Plans: 2010

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10 Industry-Changing Trends on the Pharmacy Benefit Horizon
AIS’s Quarterly Pharmacy Benefit Survey Results
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PBM Contracting and Transparency Issues and Models
Pharmacy Benefit Trends & Data
Specialty Pharmacy: Stakeholders, Strategies and Markets
Specialty Pharmacy News
Strategies to Reduce Oncology Care Costs — Without Sacrificing Outcomes

Print an order form: If you do not wish to place your order online, click here to download a printable order form (PDF file), then submit your order via fax or mail, as directed on the form.

Newsletters

DRUG BENEFIT NEWS, unique information gathered in AIS's own surveys of HMOs and pharmacy benefit management companies. Timely news and data on the business of pharmaceuticals ... and practical cost management strategies from experts throughout the industry. Includes data on high-cost drug categories, inside info on what HMOs and PBMs are doing, and information that will help you benchmark results and experiences. 24 issues annually ($537 per year) or 2-month intro ($86 for 4 issues); both include print copy and e-mail delivery.
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SPECIALTY PHARMACY NEWS, a monthly newsletter with news and strategies for managing high-cost biotech and injectable products, designed to help health plans, PBMs, providers and employers manage costs more aggressively and deliver biotechs and injectables more effectively. Contains information on benefit design, provider contracting, reimbursement, network building, claims management, formulary decisions, and other pharmacy management issues. 12 issues annually ($495 per year) or 2-month intro ($84 for 2 issues); both include print copy and e-mail delivery.
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Books, Directories & Reports


10 INDUSTRY-CHANGING TRENDS ON THE PHARMACY BENEFIT HORIZON identifies and provides all the details of 10 major trends that are changing (or should soon alter) the shape of pharmacy benefit management, from discount Rx programs to follow-on biologics to personalized medicine ... and much more. ($124) PDF version also available.
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2000-2009 SURVEY RESULTS: PHARMACY BENEFIT TRENDS & DATA, a valuable book and CD resource that features the complete results — plus analyses — of AIS’s quarterly survey of pharmacy benefit management companies, from the second quarter of 2000 to the second quarter of 2009. It contains hundreds of charts, tables and graphs on costs, benefit design, utilization and PBM market share, plus a complete directory of PBMs, PBAs, SPPs and related companies. An accompanying CD contains all of the raw survey data in spreadsheet form. ($1,275)
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AIS’s QUARTERLY PHARMACY BENEFIT SURVEY RESULTS, a unique resource containing the raw data from AIS’s quarterly survey of PBMs — that tracks growth and consolidation in the industry, and trends in costs, utilization and benefit design. Every four months, a new Excel spreadsheet is available to download, and includes data such as contact information, annual gross revenues, number of clients, number of prescriptions filled per year, and much more. ($150 per quarter)
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MEDICARE PART D: A COMPREHENSIVE ANALYSIS OF CMS RULES distills from thousands of pages of CMS regulations and guidance the major rules, guidelines and deadlines you need to comprehend the complex Medicare drug benefit program. It includes nine detailed chapters on sponsors, eligibility and enrollment, formularies, CMS enforcement and much more. ($124)
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PBM CONTRACTING AND TRANSPARENCY ISSUES AND MODELS examines which contracting strategies have been successful, and which have failed or have contributed to confusion among pharmacy benefit clients. It details the decisions that factored into many contract negotiations, both in the public and private sectors, and pays particular attention to the role of transparency in these negotiations. ($84) PDF version also available.
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SPECIALTY PHARMACY: STAKEHOLDERS, STRATEGIES AND MARKETS, a comprehensive picture of the specialty pharmacy marketplace. Includes hard data and statistics on the vendors serving this health care sector, the products involved, and the strategies employed by payers for managing and delivering these products to members. ($341) CD version also available.
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STRATEGIES TO REDUCE ONCOLOGY CARE COSTS — WITHOUT SACRIFICING OUTCOMES covers leading oncology management strategies and pricing methodologies that can help rein in costs, yet still improve overall quality and efficiency of care. This report is filled with practical examples on ways to manage oncology therapies and details of the innovative steps some health plans already have taken ... and what results they’ve achieved. ($69) PDF version also available.
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Webinars

Webinars are listed below in reverse chronological order,
with the most recent first.

HOW MORE ROBUST MEDICATION THERAPY MANAGEMENT CAN IMPROVE OUTCOMES AND LOWER COSTS, a 90-minute Webinar on September 28, 2010. Find out what steps payers are taking to comply with the new MTM requirements in the health care reform law, and what results they have achieved so far in their Medicare and commercial lines of business. You’ll hear innovative strategies for creating better MTM programs from Brand Newland, Pharm.D., vice president of Outcomes Pharmaceutical Health Care, Laurie Amirpoor, Pharm.D., staff vice president of clinical program policy at WellPoint, Inc., and Marissa Schlaifer, R.Ph., pharmacy affairs director at the Academy of Managed Care Pharmacy (AMCP). ($329)
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HOW TO INTEGRATE FDA RISK EVALUATION AND MITIGATION STRATEGY REQUIREMENTS INTO FORMULARY MANAGEMENT, a 90-minute Webinar first held on June 2, 2010. Learn about aspects of REMS that plans, specialty pharmacies and PBMs should incorporate into their utilization management programs to improve patient health and collect valuable outcomes data – from Lynn Nishida, director of clinical pharmacy services for RegenceRx, and Craig Kephart, president and CEO of Centric Health Resources, Inc. CD or On-Demand Recording available. ($329)
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HOW TO INCORPORATE OVER-THE-COUNTER DRUGS INTO PAYER FORMULARIES TO REDUCE COST AND IMPROVE ADHERENCE, a 90-minute Webinar first held on May 18, 2010. Learn about value-based insurance design, and OTC management strategies that can contain increasing prescription drug costs, improve patient adherence, monitor patient behavior and track utilization — from A. Mark Fendrick, M.D., a professor of internal medicine in the School of Medicine and a professor of health management and policy in the School of Public Health at the University of Michigan, Michael G. Cartier, Pharm.D., executive vice president of Envision Pharmaceutical Services, Inc., and Tara Higgins, a clinical pharmacist with Blue Cross & Blue Shield of Rhode Island (BCBSRI). CD or On-Demand Recording available. ($329)
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BIOSIMILAR DRUGS: PAYER STRATEGIES TO PREPARE FOR THEIR UPCOMING MARKET IMPACT, a 90-minute Webinar first held on May 13, 2010. Get the details of what health plans, employers, specialty pharmacies and PBMs can expect from the new biosimilars market, and how they can incorporate these drugs into their product design and management strategies — from three industry experts: Steve Miller, M.D., senior vice president and chief medical officer in research and clinical sciences for Express Scripts, Inc.; Mark S. Armstrong, a member of the Health Care and Life Sciences practice of Epstein Becker Green Wickliff & Hall in the firm's Houston office; and Helen Sherman, Pharm.D., senior director of pharmacy services and chief pharmacy officer at The Regence Group's RegenceRx. CD or On-Demand Recording available. ($329)
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HOW TO GUARANTEE PBM TRANSPARENCY, REDUCE RX COSTS AND MAXIMIZE PHARMACY BENEFITS, a 90-minute Webinar first held on April 1, 2010. Get insider perspectives on new initiatives plans and employers are undertaking to make sure their PBM contracts contain adequate protections and are truly transparent … and the crucial strategies Rx payers should employ to achieve the lowest feasible drug spend and save millions of dollars. Speakers are: Susan Hayes, principal of Pharmacy Outcomes Specialists; Kevin Nagle, president and CEO of Envision Pharmaceutical Services, Inc.; and F. Randy Vogenberg, PhD, RPh, Principal, Institute for Integrated Healthcare. CD or On-Demand Recording available.($329)
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NEXT-GENERATION ONCOLOGY MANAGEMENT STRATEGIES FOR HEALTH PLANS, a recording of a 90-minute audioconference held on January 28, 2010. Learn about innovative oncology management strategies that can lower costs without sacrificing patient outcomes — from Winston Wong, Pharm.D., associate vice president of pharmacy management at CareFirst BlueCross BlueShield, and Beckie Fenrick, Pharm.D., director of clinical pharmacy programs at Blue Cross Blue Shield of Florida, Inc. (BCBSF). ($329)
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HOW TO BOOST ADHERENCE WITH CHOLESTEROL DRUGS: HEALTH PLAN STRATEGIES TO IMPROVE OUTCOMES AND LOWER COSTS, a recording of a 90-minute audioconference held on January 27, 2010. Get the specifics on which strategies are most successful at boosting statin adherence, which in turn can dramatically improve patient outcomes and lower costs — from Jan Berger, M.D., chief medical officer at Silverlink Communications, and Richard A. Feifer, M.D., vice president of clinical program development for the Advanced Clinical Solutions Group at Medco Health Solutions, Inc.  ($329)
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STRATEGIES TO MANAGE SPECIALTY DRUGS IN THE MEDICAL BENEFIT, a recording of a 90-minute audioconference held on November 16, 2009. Find out how two plans have begun to manage specialty drugs in both the pharmacy and the medical benefit, and what results they are achieving. Speakers are: Donna Paine, Pharm.D., clinical pharmacy specialist at Blue Cross Blue Shield of Rhode Island; and Lynn Nishida, director of clinical pharmacy services for RegenceRx. ($329)
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HEALTH PLANS VS. DRUGMAKERS: THE BATTLE OVER COPAY SUBSIDIES, a recording of a 90-minute audioconference held on November 5, 2009. Get valuable insights and practical advice on how health plans can track and counteract pharmaceutical manufacturers’ copayment subsidy programs — from Michael Cartier, executive vice president of Envision Pharmaceutical Services, Inc., and George Van Antwerp, general manager of pharmacy solutions at Silverlink Communications, Inc. ($329)
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USING COMPARATIVE EFFECTIVENESS AND COST DATA IN DRUG-ACCESS DECISIONS: NEW HEALTH PLAN STRATEGIES, a recording of a 90-minute audioconference held on September 9, 2009. Learn what strategies health plans, PBMs and specialty pharmacy providers are pursuing to generate and utilize their own CER and cost data and/or obtain them from external sources ... and how payers are using this information to evaluate various treatment options. Speakers are: Gary Owens, M.D., president of Gary Owens Associates, Sarah Collins, president of PharManage, LLC, and Steve Miller, M.D., of Express Scripts, Inc. ($329)
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‘MONEY-BACK-GUARANTEES’ ON RX DRUGS: STRATEGIES FOR HEALTH PLANS AND PBMs TO ENSURE VALUE AND SAVE MONEY, a recording of a 90-minute audioconference held on June 11, 2009. Get reliable information on creating performance-based pharmaceutical contracts, and learn what your organization should do now to prepare for this emerging trend. Speakers are two of the leading architects of this concept – Christina J. Barrington, Pharm.D., director of pharmacy at Health Alliance Medical Plans, and Thomas O. Stambaugh, vice president and chief clinical officer of CIGNA Pharmacy Management. ($329)
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NEW CMS MEDICATION THERAPY MANAGEMENT RULES: WHAT PART D SPONSORS MUST DO TO COMPLY AND SUCCEED, a recording of a 90-minute audioconference held on April 30, 2009. Learn what actions health plans and PBMs must take to comply with CMS’s tough new 2010 medication therapy management requirements. Tim Sawyers, director of clinical pharmacy services at HealthSpring, Inc., and Denise Kehoe, vice president of business development at PharmMD, will provide insight on how CMS’s rules will alter your existing MTM program, and improve members’ health and your plan’s bottom line. ($329)
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COMPARATIVE EFFECTIVENESS FUNDING: THE LIKELY IMPACT OF $1.1 BILLION ON HEALTH PLANS AND PBMs, a recording of a 90-minute audioconference held on March 24, 2009. Three leading experts — EPS, LLC’s  F. Randy Vogenberg, Ph.D., and Alston & Bird’s Colin Roskey and Mark Rayder — offer insights into which strategies Rx stakeholders should develop to take advantage of the more than $1 billion in funding for comparative effectiveness research (CER) contained in the economic stimulus law. ($329)
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COMPLYING WITH CMS’S NEW ‘LOCK-IN PRICING’ RULE: IMMEDIATE STEPS PART D SPONSORS MUST TAKE, a recording of a 90-minute audioconference held on March 19, 2009. Learn to read and renegotiate contracts with PBMs, and develop mechanisms for implementing the “negotiated price” provision, to reduce your risk of severe sanctions and significant monetary penalties — from Steve Arbaugh of ATTAC Consulting Group and Susan Hayes of Pharmacy Outcome Specialists. ($329)
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PERSONALIZED MEDICINE: HEALTH PLAN STRATEGIES TO IMPROVE OUTCOMES AND CONTROL RX COSTS, a recording of a 90-minute audioconference held on February 26, 2009. Felix Frueh, Ph.D., vice president of research and development and personalized medicine at Medco, and Lynn Nishida, director of clinical pharmacy services for RegenceRx,will provide strategic insight on how health plans, PBMs and other stakeholders can make sense of recent developments in personalized medicine, and use the concept to improve members’ health outcomes and control pharmaceutical spending. ($329)
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INNOVATIVE ONCOLOGY PARTNERSHIPS: HOW TO IMPROVE OUTCOMES AND EFFICIENCIES, a recording of a 90-minute audioconference held on October 29, 2008. A team of experts — Lynn Nishida, director of clinical pharmacy services for RegenceRx, Richard McGee, M.D., a medical oncologist and co-founder and president of Puget Sound Cancer Centers, Nicholas Opalich, the managing principal of Strategica Health Partners, L.L.C., and David Chess, M.D., founder and CEO of Enhanced Care Initiatives Inc.— outline effective strategies that payers and providers can use collaboratively to improve clinical outcomes and increase efficiencies. ($329)
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VACCINE COVERAGE AND BILLING STRATEGIES UNDER PART D, a recording of a 90-minute audioconference held on September 25, 2008. Andrea Serrate, CPA, vice president of specialty and payer services for Poc Network Technologies, Inc., provides valuable intelligence about CMS’s new vaccine coverage and administration billing requirements and options. Learn how to cover and bill for vaccines correctly to avoid CMS sanctions and enforcement action. ($329)
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FINDING ‘VALUE’ IN VALUE-BASED Rx BENEFITS: ROI STRATEGIES FOR HEALTH PLANS AND EMPLOYERS, a recording of a 90-minute audioconference held on September 18, 2008. Two leading experts on value-based programs — Jack Mahoney, M.D., corporate medical director and global health care management director at Pitney Bowes Inc., and Brian Sweet, chief pharmacy officer at WellPoint, Inc. — offer their strategic insights on how health plans and self-insured employers can see a significant return on investment out of their value-based insurance design (VBID) programs. ($329)
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NEXT-GENERATION SPECIALTY PHARMACY MANAGEMENT STRATEGIES FOR HEALTH PLANS, a recording of a 90-minute audioconference held on July 9, 2008. Find out what new strategies insurers are using — and should use — to manage high-cost specialty drugs, from Debbie Stern, R.Ph., vice president of Rxperts, and Edmund Pezalla, M.D., national medical director at Aetna Pharmacy Management. ($329)
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HOW TO LOWER RX COSTS IN PBM CONTRACTS: STRATEGIES FOR HEALTH PLANS AND EMPLOYERS, a CD of a 90-minute audioconference held on June 12, 2008. Get expert guidance about the RFP process, PBM contracts, and the crucial strategies Rx payers should employ to achieve the lowest feasible drug spend — and not waste millions of dollars. Speakers are: Linda Cahn, president of Pharmacy Benefit Consultants, and Dan Coady, director of pharmacy benefit administration (PBA) strategies at HealthTrans LLC. ($329)
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PART D ENFORCEMENT PITFALLS: HOW TO IDENTIFY AND ELIMINATE FRAUD AND ABUSE IN YOUR DOWNSTREAM ENTITIES, a CD of a 90-minute audioconference held on March 13, 2008. Find out urgent new compliance challenges Part D plans face in light of CMS’ recently finalized regs that increase sponsor responsibilities for downstream entities … and learn steps you can take to identify and eliminate fraud and abuse at the various contact points for beneficiaries. Hear from Susan Hayes, principal and founder of Pharmacy Outcome Specialists and Steve Arbaugh, principal with ATTAC Consulting Group, LLC. ($329)
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ORAL ONCOLOGY DRUGS: HEALTH PLAN STRATEGIES FOR AN EVOLVING MARKET, a CD of a 90-minute audioconference held on February 28, 2008. Find out what strategies plans are (or should be) using to manage oral oncology drugs, and what trends insurers should prepare for — from Lee N. Newcomer, M.D., senior vice president of oncology for UnitedHealthcare, Randy Falkenrath, senior vice president of specialty pharmacy and business development for UnitedHealth Pharmaceutical Solutions (UHPS), and Thomas McNulty, Pharm.D., chief clinical officer for Ancillary Care Management, Inc. (ACM). ($329)
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“DRUG MIX” STRATEGIES FOR HEALTH PLANS AND PBMs: WAYS TO LOWER Rx COSTS AND WIN BUSINESS, a CD of a 90-minute audioconference held on February 13, 2008. Three leading pharmacy experts — Jake Cedergreen of Express Scripts, Helen Sherman of The Regence Group's RegenceRx and Tim Watson of Pharmaceutical Strategies Group — provide strategic insights on how health plans and PBMs can develop an effective drug mix, and thereby differentiate themselves in the marketplace. ($329)
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