Finding ‘Value’ in Value-Based Rx Benefits: ROI Strategies for Health Plans and Employers


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Guide to Medicare Reform Law: Overview and Highlights for Health Plans, Hospitals and Providers

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Price: $84
Pages: 236
ISBN: 1-931467-69-2
© 2004
Pub Code: BMRL

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 is expected to have a huge, highly favorable impact on health plans, PBMs, providers and other health care organizations. It contains numerous enticements, including much higher reimbursement rates and an authorization for regional PPOs. It also creates terrific new revenue opportunities for PBMs and pharmaceutical producers.

The Act is long and complicated, but its provisions have a major impact on every type of provider. From the new prescription drug benefit provisions, to significant changes in the payment for drugs and biologicals under OPPS, to revision of how to appeal a Medicare claim denial — all of these issues and much more is contained in the 678-page Medicare legislation and explained in the 403-page Conference report from the House and Senate conference committee. Those 1,000+ pages are intimidating, but the Guide to Medicare Reform Law: Overview and Highlights for Health Plans, Hospitals and Providers has done the work for you. AIS reporters and editors have combed all the pages and extracted summaries and explanations of the present law and the legislative changes. We've organized the information into an easy-to-read format and added a detailed table of contents for each of the 12 titles of the Act, which will get you to where you want to go — quickly.

 

Table of Contents

(Highlights from the detailed Table of Contents in the printed report.)

TITLE I: Medicare Prescription Drug Benefit

  • Part D Eligible Individuals and Prescription Drug Benefits
  • Prescription Drug Plans; PDP Sponsors; Financing
  • Application to Medicare Advantage Program and Treatment of Employer-Sponsored Programs and Other Prescription Drug Plans
  • Medicare Prescription Drug Discount Card and Transitional Assistance Program
TITLE II: Medicare Advantage
  • Implementation of Medicare Advantage Program
  • Immediate Improvements
  • Offering of Medicare Advantage (MA) Regional Plans; Medicare Advantage Competition
  • Additional Reforms

TITLE III: Combatting Waste, Fraud and Abuse

TITLE IV: Rural Provisions

  • Provisions Relating to Part A Only
  • Other Provisions

TITLE V: Provisions Relating to Part A

  • Inpatient Hospital Services
  • Other Provisions

TITLE VI: Provisions Relating to Part B

  • Provisions Relating to Physicians' Services
  • Preventive Services
  • Other Provisions
  • Additional Demonstrations, Studies and Other Provisions

TITLE VII: Provisions Relating to Parts A and B

  • Home Health Services
  • Graduate Medical Education
  • Chronic Care Improvement
  • Other Provisions

TITLE VIII: Cost Containment

  • Cost Containment
  • Income-Related Reduction in Part B Premium Subsidy

TITLE IX: Administrative Improvements, Regulatory Reduction and Contracting Reform

  • Regulatory Reform
  • Contracting Reform
  • Education and Outreach
  • Appeals and Recovery
  • Miscellaneous Provisions

TITLE X: Medicaid and Miscellaneous Provisions

  • Medicaid Provisions
  • Miscellaneous Provisions

TITLE XI: Access to Affordable Pharmaceuticals

  • Access to Affordable Pharmaceuticals
  • Federal Trade Commission Review
  • Importation of Prescription Drugs

TITLE XII: Tax Incentives for Health and Retirement Security

 

Written By

This book was written by the editorial staff of AIS.

 

Written For

  • Health plan CEOs, strategic planners, product development and marketing executives, financial managers, and pharmacy directors
  • Executives at pharmacy benefit management companies
  • Pharmaceutical company executives and marketers
  • Directors of managed care contracting for providers
  • Self-insured employers

 

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Print Rush Orders: Please call us at 800-521-4323 to place a rush order. We will overnight your order for an additional charge of $30, or you can give us your FedEx or UPS account number and we will charge the shipping to your account. Rush orders placed after 3:00pm EST will not be shipped out until the next business day.

 

Related Publications

Managed Medicare and Medicaid Factbook
Medicare Advantage News
Health Plan Week
Health Plan Facts, Trends and Data
Pharmacy Benefit Trends & Data
Health Plans and Disease Management: The New Environment

 

For further information call 800-521-4323 or e-mail customerserv@aispub.com

 
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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.

Related Publications

Managed Medicare and Medicaid Factbook

Medicare Advantage News

Health Plan Week

Health Plan Facts, Trends and Data

Pharmacy Benefit Trends & Data

Health Plans
and Disease Management: The New Environment

 


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