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States limiting patient costs for high-priced drugs
The Pew Charitable Trusts
As more expensive specialty drugs come on the market to treat some of the most serious chronic diseases, more states are stepping in to cushion the financial pain for patients who need medicine that can cost up to hundreds of thousands of dollars a year.
At least seven states — Delaware, Louisiana, Maine, Maryland, Montana, New York and Vermont — limit the out-of-pocket payments of patients in private health plans. Montana, for instance, caps the amount that patients pay at $250 per prescription per month. Delaware, Maryland and Louisiana set the monthly limit at $150 and Vermont at $100. Maine sets an annual limit of $3,500 per drug.
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Specialty medication spend is significant and growing
Spending on high-cost specialty medications grew 24 percent in just a year — nearly three times the growth rate seen in traditional health plans — largely attributable to hepatitis C medications, which are now the third costliest therapy class among exchange plans.
Specialty medications accounted for 42 percent of all pharmacy spending among exchange plans. Nearly 53 percent of exchange plan specialty pharmacy claims were for HIV, compared to 20 percent for traditional health plans.
What others are saying about high-priced drugs; MHPA's Myers comments
California Association of Health Plans
Several high-profile individuals familiar with full-service health plans commented on the issues of high-priced drugs. Among those was MHPA president and CEO Jeff Myers.
"This study is further evidence that we simply do not have the resources to pay for these treatments at their current prices," Myers said. "Since hepatitis C disproportionately affects the Medicaid population, state Medicaid programs like California's Medi-Cal will be hardest hit.
"This inability of states to pay as a result of pharmaceutical companies' pricing model is a barrier to eradicating hep C. Imagine if Jonas Salk did this for the polio vaccine — the iron lung would not be a thing of the past. It boils down to this: Are these treatments really miracle cures if no one can afford access to them?"
Obamacare ruling paves the way for lobbying blitz
Healthcare lobbyists across Washington are hoping to win long-sought changes to Obamacare now that the Supreme Court has affirmed the law is here to stay. Last week's ruling in King v. Burwell has unfrozen the field for dozens of healthcare groups that have been stymied in their efforts to tweak the law while it was still fighting for survival in the courts.
Barack Obama takes an Obamacare victory lap
Obamacare is the law of the land, President Barack Obama says, and it's time for Republicans who oppose it to move on. That's the message a jocular, relaxed Obama delivered during a visit to Tennessee on Wednesday, taking victory lap just six days after the Supreme Court upheld the legislation that created Obamacare in a case known as King v. Burwell.
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Louisiana ending program that pays for private insurance for some Medicaid recipients; testament to managed care's success
Louisiana's state health agency will end a special program under which it has been paying for private insurance for some Medicaid recipients. The Louisiana Health Insurance Premium Payment, or LaHIPP, program serves 1,500 households and will go away Dec. 1 as a cost-saving measure.
Missed an issue of MHPA's Industry NewsBrief? Click here to visit the brief's archive page.
5 Medicaid providers get new Kentucky contracts
Kentucky has awarded new contracts to the five private companies that manage its rapidly expanding Medicaid program, its growth fueled by hundreds of thousands of new members under the Affordable Care Act. The growth has been a windfall for some of the companies over the past year, but the new contracts are designed to limit potential profits and address complaints about slow payments and excessively complicated forms and procedures.
Study finds doctors order fewer preventive services for Medicaid patients
Kaiser Health News
Gynecologists ordered fewer preventive services for women who were insured by Medicaid than for those with private coverage, a recent study found. The study by researchers at the Urban Institute examined how office-based primary care practices provided five recommended preventive services over a five-year period. The services were clinical breast exams, pelvic exams, mammograms, Pap tests and depression screening.
mhpa2015 registration now open!
MHPA via YouTube
Thanks to all of you who made our 2014 annual conference a smashing success. For a recap of the event, please watch this short video.
This year, we will examine Medicaid's 50-year evolution through thought-provoking sessions on the latest in managed healthcare operations, policies and populations, as well health plan best practices. Please visit our mhpa2015 home page for info on registration, lodging and sponsorships.
For more information, please contact Erin Liberatore via email or by phone at 202-857-5773.
July 15 Webinar Wednesday: 'Delivering Healthy NICU Outcomes through a Coordinated Model'
Many times, it's the most fragile members that use the most resources. ProgenyHealth addresses this by managing the care coordination delivered to infants admitted to the NICU. Join Jerry Lee, M.D., and Letitia Lieb, MHA, medical director and strategic business executive, respectively, for ProgenyHealth to discuss specialized population management in managed care that's expected to improve outcomes and save costs.
The webinar will preview some of the successes achieved through collaborative partnerships with providers, families and managed care plans. Specific findings will be discussed that address current NICU trends and variations in care.
July 29 Webinar Wednesday: 'Transforming Medicaid
Member Communications' (rescheduled from July 8)
Join Neng Bing Doh, CEO of HealthCrowd, for a presentation on how macro healthcare trends are requiring a transformation in Medicaid member communications. This webinar will cover current hot topics including how to scale text messaging programs to affect HEDIS scores, using multiple modalities "in concert" to improve member experience while optimizing outreach budget, the need to move away from transactional communications, and how to make each outreach campaign better than the last. Accompanied by case studies and even comics, this webinar will be one every health plan employee can derive value from.
Did you miss Webinar Wednesday: 'The New Frontier: Measuring Patient Engagement and Experience' by Avalere?
View and listen to the webinar recording.
For additional information, please contact Madeline Abram, visit www.avalere.com or follow Avalere on Twitter.
For copies of other past webinars, visit here.
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Job opportunity: Senior Medicaid Strategist | Raleigh-Durham, NC
North Carolina Department of Health and Human Services
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Job opportunity: RN, manager, Clinical Health Services,
pre-authorization | Detroit
Aetna seeks an experienced RN with managed care, leadership and prior authorization expertise. Reinforces clinical philosophy, programs, policies and procedures. Ensures implementation of tactics to meet strategic direction for cost and quality outcomes. Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
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