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Managed Care March 2008	PDP Drug Restrictions Block Comparison Shopping A review of 169 commonly used drugs covered by Medicare Prescription Drug Plans (PDPs) reveals that only 4 of the 10 largest plans by enrollment have all of those 169 drugs on formulary.
Managed Care February 2005	Medicare's Drug Coverage Seeks To Strike Compromise Health plan officials are still trying to determine just how the final rules for the new Medicare prescription drug benefit will affect them, because it appears that government officials tried their best to address the competing concerns of all players.
Managed Care August 2004 Martin Sipkoff	Bad Tiered Formulary Designs Yield Poor Outcomes, High Cost Now that tiered formularies rule the land, what many suspected is being demonstrated: Compliance is suffering and so, too, are patients.
Managed Care November 2004 John Carroll	Medicare Formulary Model Seen by Many as Too Inclusive The issue is how extensive the list of covered medications should be for the new Medicare pharmaceutical benefit. The stakes are enormous.
Managed Care May 2005	Implementing Medicare Part D Could Get Ugly This expert who hopes to help everybody adjust, nevertheless expects big headaches come Jan. 1, 2006. However, e-prescribing could make the drug plan work.
Managed Care November 2004 Tony Berberabe	Military Brings Order To Formulary System Congress told the Department of Defense to create a uniform formulary for all the services, and cover all FDA-approved drugs.
Managed Care June 2006 Martin Sipkoff	Limiting Access to SSRIs Does More Harm Than Good Despite the higher costs of SSRIs, compared to older antidepressants, limiting members' access can lead to undertreated depression.
Pharmaceutical Executive January 1, 2012 Christopher J. Piazza	Essential Questions for Essential Benefits A key consideration under the Affordable Care Act is how states select plans for drug coverage.
Managed Care November 2005 Martin Sipkoff	Confusion Rules the Day As Medicare Part D Begins With a dizzying array of coverage possibilities, there is a strong possibility that some people who would benefit will fail to enroll in any plan.
Pharmaceutical Executive February 1, 2014 Jill Wechsler	Drug Coverage, Costs Under Scrutiny Benefits offered by insurance plans on health exchanges and through Medicare are raising concerns about patient access to needed therapies
Pharmaceutical Executive October 1, 2008 Jill Wechsler	Part D Under Attack Congressional leaders ready campaign to curb Medicare drug plans.
Managed Care December 2006 Martin Sipkoff	Federally Negotiated Drug Prices Anticipated for Medicare Part D Congress to force the issue of federally negotiated drug prices. This could eventually lead to a government-run drug plan.
Managed Care February 2007 Martin Sipkoff	What's Good for the VHA Is Not So Good for Medicare Fundamental differences in program structure between Medicare and the Veterans Health Administration make drug pricing negotiations problematic.
Managed Care May 2006 Martin Sipkoff	Part D Means Health Plans Will Have To Pay Pharmacists Medication therapy management helps people to stay on their prescribed regimens. Part D plans can expect to start making payments for the service in 2007.
Pharmaceutical Executive May 1, 2006 Huang, Pesile & Mozeson	Medicare Part D: D for Doomed? New drug coverage plans cost more money and serve fewer patients than the government expected. What if things get worse? Here are two scenarios for disaster.
Managed Care December 2007 Martin Sipkoff	Large Plans Do Well Under Part D, But Premium Hikes Cloud Future Profits should increase over the next two years for plans that stay the course, but politics and rising premiums may affect long-term results.
Managed Care February 2002 Bob Carlson	Proposal To Regulate Formularies Draws Sharp Difference of Opinion The National Association of Insurance Commissioners has spent two years developing a model. Drug companies like it; health plans don't...
Managed Care February 2006 Martin Sipkoff	Don't Bet That Problems With Part D Are Over Medicare Part D enrollment snags could be just the start of political and regulatory headaches facing health plans and pharmacy benefit managers.
Pharmaceutical Executive November 1, 2005 Jill Wechsler	Washington Report: Out of Commission? Crawford Steps Down The clouded circumstances of the commissioner of the Food and Drug Administration may complicate the process of securing a permanent leader. Meanwhile, battles continue over hot-button issues such as the morning-after pill and the regulation of follow-on biologics.
Managed Care August 2007	Incentive Formularies Have Minimal Effect A brief look at the effect of changes in drug benefit design on pharmaceutical use and spending.
Managed Care March 2006 David Adler	Tiers Reach New Heights Under Part D Can commercial health plans learn from Medicare Advantage Prescription Drug Plans that have four or more formulary levels?
Registered Rep. October 13, 2011 Mark Miller	Determining Your Elderly Clients' Best-Fit in Medicare Plans You may be able to help senior clients save thousands of dollars in out-of-pocket health care costs by encouraging them to comparison shop for Medicare prescription drug and managed care options during the program's annual fall enrollment season.
The Motley Fool January 22, 2007 Michael P. Cecil	Will Medicare Negotiate With Drug Companies? One of the bedrock principles of our economic system is that those buying more of a product receive a discount. Wouldn't empowering Medicare to save taxpayers' money be widely embraced as a great idea? But how would pharma investors see it?
Managed Care August 2001 Steve Perlstein	Four-Tier Approach Injects Consumerism Into Drug Benefit In tying copayments closely to the actual cost of medications, Humana takes a step toward promoting awareness of resource use...
Pharmaceutical Executive February 1, 2006 Jill Wechsler	Washington Report: Cross-Agency Collaboration for Part D Medicare Part D gives CMS more clout over coverage, pricing, and even drug development.
Managed Care May 2001	Old Ideas About Formulary Structure Gone as Humana Tests 4-Tier Model Humana is phasing in a four-tier formulary that categorizes prescription drugs by costs, rather than generic or brand status. The higher the drug's acquisition cost -- regardless of whether it's a branded or generic product -- the higher the tier it lands in...
Registered Rep. January 2, 2013 Kevin McKinley	Mapping the Medicare Maze Advisors can shed some much-appreciated light on this crucial but confusing program.
Pharmaceutical Executive May 1, 2014 Jill Wechsler	Reimbursement Limits Threaten Drug Access High cost-sharing, narrow formularies create problems for pharma companies and patients.
Pharmaceutical Executive August 1, 2005 Kevin Barnett	Part D Phase 2 Pharmaceuticals have been scrambling to get their Medicare contracting in order. Now it's time to figure out part D marketing and sales. Here's a checklist for the months ahead.
Managed Care October 2001 Michael Levin-Epstein	Medicare+Choice Reform: Hope, but No Quick Action Expected There have been small accomplishments, and wheels have been churning for more forceful action -- that is, they were until Sept. 11...
Pharmaceutical Executive June 1, 2005 Jill Wechsler	Washington Report: "D" Is for Data It is critical for Medicare to address important questions on drug safety and utilization, and about how prescribing decisions affect health outcomes and costs.
BusinessWeek May 1, 2006 Howard Gleckman	Medicare Surprise Why many seniors could temporarily lose drug coverage.
Managed Care October 2002	Though M+C Erosion Slows, Reimbursement Still an Issue The exodus of health plans from Medicare+Choice will moderate somewhat next year, offering hope that the struggling system can make a comeback.
Pharmaceutical Executive February 1, 2012 Jill Wechsler	Costs and Benefits of Health Reform Will expanded markets and accountable care organizations offset higher rebates, added fees, and closer scrutiny of marketing and prices?
Financial Planning February 1, 2006 Janet Aschkenasy	Drug Deals Here is how to help your financial advisory clients make sense of Medicare Part D.
Managed Care March 2002	How Medicare beneficiaries spend money on drugs The Kaiser Family Foundation notes that Medicare beneficiaries account for 14 percent of the U.S. population, but for 43 percent of the nation's spending on prescription drugs. Thirteen percent of beneficiaries had to pay $2,000 or more out of pocket in 2001...
Pharmaceutical Executive June 1, 2013 Jill Wechsler	Washington Report: Innovation, Coverage, and Costs The backlash against high prices for new medicines will impact research, patent exclusivity, and drug benefits.
Managed Care April 2007 MargaretAnn Cross	Do P&T Committees Have Enough Power? Plans and PBMs are divided about sharing drug prices with clinicians. Is it better to have an administrative committee determine the formulary?
Managed Care March 2002 Michael Levin-Epstein	Illinois's Medicare Drug Program Called 1st Stab at National Reform The Illinois demonstration program gives the state permission to use federal and state Medicaid dollars to provide prescription drug coverage for 365,000 low-income, elderly Medicare beneficiaries...
Managed Care August 2002 Madeleine A. Estabrook	Regulators Take More Interest In Role of PBMs in Health Care In a highly regulated industry such as health care, it is just a matter of time before every component of the industry comes under scrutiny and review. Pharmacy benefit managers are taking center stage now.
Managed Care October 2004 Arthur Lazarus	Formulary Restrictions Sometimes Harm Patients Much more research is needed to determine the full effect of drug benefit designs. Quality must be the foremost concern.
Pharmaceutical Executive December 1, 2008 Jill Wechsler	Challenge and Challenges Expanded healthcare coverage also fits the goals of pharma manufacturers.
Pharmaceutical Executive February 1, 2007 Patrick Clinton	From the Editor: Meaningless A bill requiring the Secretary of Health and Human Services to negotiate Medicare drug prices directly with pharmaceutical manufacturers has a fatal flaw.
Searcher October 2011 Stephanie C. Ardito	The Medical Digital: Navigating the Medicare Maze Since entitlement programs are the chief governmental programs under fire, I decided to revisit the healthcare bills passed back in March (H.R. 3590, the Patient Protection & Affordable Care Act).
Managed Care March 2007	Use of Generics On the Rise Recent data indicate that generic medication accounts for nearly 60% of the drugs dispensed to people in Medicare Prescription Drug Plans and Medicare Advantage plans.
Pharmaceutical Executive November 1, 2012 Lauri Mitchell	Who Pays for Specialty Medicines? Providers and patients fish for that delicate balance between access and abandonment.
Managed Care October 2005 Martin Sipkoff	Restrictive Formularies May Be Contagious It's the law of unintended consequences: A restrictive drug formulary maintained by a health plan may influence how physicians treat patients unaffiliated with that plan. What does this mean to managed care?
Managed Care July 2002 Thomas Kaye	Managing the Drug Benefit: One Company's Experience The pharmacy director of Blue Cross of Oklahoma shares his company's success with using three tiers and coinsurance to promote member responsibility.
Managed Care February 2007	Managed Care Outlook Coverage for children leads policy debate.
Registered Rep. November 1, 2005 Lynn O'Shaughnessy	Medicare Drug Benefit 101 If financial advisers can understand the basics of the new Medicare drug benefit plan, they can provide a great service to their clients -- perhaps even save them money in premiums. Here's where to start.