Tag:

Aetna said...that it won't sell individual coverage next year in its two remaining states - Nebraska and Delaware - after projecting a $200 million loss this year. It had already dropped Iowa and Virginia for next year. The insurer once sold the coverage in 15 states, but slashed that to four after losing about $450 million in 2016...The government-backed marketplaces are a pillar of the Obama-era federal law because they allow millions of people to buy health insurance with help from income-based tax credits. But insurers like Humana, and now Aetna, have been fleeing that market, and the remaining coverage options are growing thin…

APhA releases position on health care...the future of health care continues to be a major focus of Congress, the American Pharmacists Association emphasizes the importance of patients’ access to care, including pharmacist-provided services and safe and affordable medications. APhA Executive Vice President and CEO Thomas E. Menighan issued the following statement further explaining APhA’s position on health care:

Consistent with our recommendations related to the Affordable Care Act and other health care reforms, APhA continues to call for policies that support patient access to and coverage of —pharmacists’ patient care services, the pharmacy of their choice, and safe and affordable medications. An important component to providing access is ensuring adequate reimbursement to pharmacists for their patient care services and to pharmacies for medications and other products. Securing enactment of these policies increases access, improves quality and decreases costs...APhA strongly advocates for a health care system better structured to optimize the skills and expertise of practitioners, including pharmacists, to provide the best care to patients and value to the system…

After being blocked by a federal court, Aetna Inc. and Humana Inc. have decided to terminate their $37 billion merger deal...The health insurance giants said...that, with the move, Aetna will pay Humana a $1 billion breakup fee...In January...the...District Court for the District of Columbia ruled in favor of the Department of Justice’s request to enjoin the Aetna-Humana merger. The government claimed that the combination of the two health insurers would lessen competition, harming seniors who buy private Medicare coverage and some consumers who buy health insurance on public exchanges...The consolidation wave hitting the health insurance sector has been seen as a byproduct of the Affordable Care Act. The mega-deals would provide fast access to the millions of people who have gained health coverage under the ACA and would be a vehicle for capturing Medicaid business, which has expanded dramatically under the health reform law...the climate for mergers and acquisitions in the health care sector has become uncertain. Besides the DOJ’s opposition to the mega-mergers, the Trump administration and Republican leaders in Congress have begun efforts to dismantle the ACA. That has cast a cloud on the health insurance marketplace, since it remains unclear what would replace the ACA and how consumers who have obtained coverage via the exchanges would continue to receive benefits.

Humana, UnitedHealthcare, WellCare, Blue Cross and Blue Shield of Florida, Blue Cross and Blue Shield Northern Plains Alliance and CVS Health are among those participating in the Part D model that gives insurers financial incentives when they offer innovative programs that encourage seniors to take their medications...The experiment comes out of the Affordable Care Act…Evidence suggests that medication therapy services currently offered by Part D plans don't improve quality or reduce unnecessary medical expenditures. That's likely due to misaligned financial incentives and regulatory constraints…The focused approach is critical Medicare Advantage plans currently have more of an incentive than stand-alone Part D plans to work with patients to take their medications because they are on the hook for hospitalizations…The Medicare Advantage value-based insurance design model will begin Jan. 1, 2017, and run for five years…

There are a lot of health insurance bills at state legislature this session, as there is great concern about what will happen if Congress does "Repeal and Replace" ObamaCare...After 7 years of the Affordable Care Act, we’re all kind of used to the bill that has provided subsidized insurance to about 80,000 Nevadans and expanded Medicaid coverage to about 300,000...Chair of the Assembly Health and Human Services Committee, Mike Sprinkle of Sparks, has a bill that would remove the income limits on the state’s Medicaid program and open it up to Nevadans who want to buy. People would be able to buy insurance on the Silver State exchange for a certain amount, while current Medicaid recipients could continue to receive government assistance through the program...I was opposed to expanding Medicaid in Nevada, as I was concerned about the cost to taxpayers. But maybe its expansion is actually helping lower costs for all of us. I’m not totally sold, but I’m more open to ideas like Assemblyman Sprinkle’s after a few years of seeing it actually enacted...By doing what is "morally" right — helping low-income and working class families access healthcare — may turn out to be fiscally right. But if you disagree, bring it on!

Spending on prescription drugs for health plans created under the Affordable Care Act increased last year at a rate more than three times that of other commercial plans and most government-run plans managed by Express Scripts Holding Co...year-over-year spending per person for individual insurance plans sold on the Obamacare exchanges where it manages the pharmacy benefit rose 14 percent in 2016, driven by higher drug prices and utilization...Express Scripts said per-capita spending for other commercial plans it manages, mostly for employers, rose just 3.8 percent last year, despite an 11 percent increase in list prices for brand-name drugs...Drug spending for plans the company manages under Medicare...increased 4.1 percent last year while the rise for Medicaid...was 5.5 percent.

...the McKesson Pharmacy Optimization team...has identified the top five trends that will impact hospital and health system pharmacies in 2017...McKesson's advisory team addressed these trends with health system pharmacy leaders at the American Society of Health-System Pharmacists Midyear Clinical Meeting 2016...The role of the clinical pharmacist is rapidly expanding to stay ahead of the changing dynamics brought upon by healthcare reform...The expanding scope of pharmacists’ service and increasing clinical collaboration illustrate key trends and opportunities facing health system pharmacies in the coming year...here are the five trends McKesson's pharmacy optimization team identified:

• Continued Growth in Specialty Market
• Leveraging Pharmacy Analytics to Make Strategic Business Decisions
• Health System Pharmacy Seen as a Revenue and Margin Generator
• Centralizing Pharmacy Operations and Improving Clinical Services
• Future Directions for Reform and the Affordable Care Act

At the Academy of Managed Care Pharmacy Annual Meeting, held March 27-30...in Denver...the cost of healthcare was on everyone’s minds and was a common thread in most sessions...Here are 5 key takeaways from the meeting.

1. Value frameworks were on people’s minds...AMCP sees value frameworks as a tool that can help with the formulary decision making process…
2. They are increasingly being used by payers...a survey of payers from the beginning of 2016 found that 26% were currently using value frameworks and an additional 22% planned to use them in the next 12 months. Only 19% had no plans to use value frameworks…
3. Frameworks are just 1 solution centering on value…the National Pharmaceutical Council, outlined 3 other solutions that center around value. These include value-based insurance design, value-based contracting, and financing...
4. Change is coming to healthcare...L.E.K. Consulting, followed the money in healthcare and came to the conclusion that healthcare is an unsustainably big business, which necessitates change.
5. Obamacare repeal isn’t the only legislation to watch...Republicans may not have gotten the American Health Care Act, which would repeal and replace the Affordable Care Act, through the House of Representatives, but there could be future efforts to bring the legislation back in another form…

Nevada Gov. Brian Sandoval said Saturday he would take his concerns about the overhaul of the Affordable Care Act to Capitol Hill where lawmakers are mulling over various proposals to replace Obamacare...The nation’s governors, in town for their annual meeting, are expected to spend Monday talking with Republican leaders and members of Congress about repeal and replacement of the health care act...Many states, including Nevada, broadened Medicaid programs to take advantage of federal funds to help insure more elderly and poor. Officials in those states are concerned about how the federal government will continue its funding commitment for the expanded programs...Sandoval said congressional overhaul of the ACA is a top concern for governors and that the “conversation is ongoing.”...

It may not feel like it, but Nevadans who get their health insurance courtesy of the Affordable Care Act can consider themselves relatively lucky as 2017 comes into focus...Yes, they will pay an average of 11 percent more in premiums for their coverage than they did this year. And, yes, many will only be able to pick from plans offered by a single insurer...But it could have been far worse. Proof lies just across the border in Arizona, where some premiums are skyrocketing by triple digits and most insurers have fled the market...A new federal report on insurance premium prices released earlier this week and a county-level analysis published...by the Associated Press and consulting firm Avalere Health painted a comprehensive picture of the state of ACA health care insurance entering 2017...It wasn’t pretty...report by the Department of Health and Human Services showed that premiums for a midlevel benchmark plan will increase an average of 25 percent in 2017 across the 39 states served by the federally run online market, including Nevada...HHS officials noted that a majority of those who purchase plans through HealthCare.gov and its state-run counterparts – including Nevada’s Silver State Health Insurance Exchange — receive financial assistance and may not see their out-of-pocket expenses increase much, if at all. It may not feel like it, but Nevadans who get their health insurance courtesy of the Affordable Care Act can consider themselves relatively lucky as 2017 comes into focus.