Free e-Newsletters

This electronic newsletter from ePharmaceuticalsT delivers weekly, first-hand reports of marketplace responses to Medicare changes, including provisions from the new drug benefit. Breaking news reports, voice-of-customer intelligence, and expert analysis will provide pulse-checks of how these changes will affect the pharmaceutical industry and your brand.

2009 | 2008 | 2006 | 2005

Medicare & Reimbursement Advisor Weekly

Issue 40, December 11, 2009 - VIEW THE FULL ISSUE

• Sales, managed care synergy vital in health reform evolution

  When you are considering sales and managed care marketing and account team synergy in the next era...

• P&T committee debates bidding impact, interchange

  At a recent Alaska Medicaid P&T committee meeting, Jeffrey Demain, MD, discussed the impact of...

• Conversation: Hospital GPO uncovers diabetes, DM opportunities

  Premier is a hospital GPO with about 2,000 individual hospital members and is a key customer if you...

• Breaking down silos in managed care

  To evaluate costs versus outcomes in the most expensive categories, more payers are integrating...

• Did adherence survey forget about formulary influence?

  Editor’s note: Someone contacted me recently about a new program designed to help patients...

Issue 39, December 4, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Prior authorization costs: What are they?

  For those who are curious, prior authorizations (PA) may be a safety and utilization management...

• Mild utilization and prior authorization requests not enough to gain preferred drug list status

  The following is a brief lesson about the intricacies of Medicaid’s formulary committee...

• How PDL committee tracks prior authorization trends

  The chart below illustrates the number of prior authorizations (PA) approved by month in Louisiana...

• How practices deal with injectable administration denials; UnitedHealthcare among focus areas

  As you approach your commercial accounts, keep these trends in mind that are hurting your physician...

• Wholesale acquisition cost reimbursement uptake means more consistency for providers, payers

  The following are some trends circling in the reimbursement universe: First Data Bank is...

Issue 38, November 20, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Conversation: Texas medical director

  As a managed markets professional, I thought this comment from a medical director I spoke to this...

• Cardiologists, oncologists, other specialty customers affected by unheralded Medicare cut

  If you have a product prescribed by specialty physicians, consider this: Next year’s...

• Payers may forgo PA restrictions in more collaborative model

  Even if the products you support are orals for cardiovascular conditions, the following may be...

• Trends: Copay, out-of-pocket collection down in LTC

  Results of six skilled nursing facility polls show some of the trends in LTC and indirectly suggest...

Issue 37, November 13, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Medication management at discharge takes back seat

  Health plans won’t love this: St. Joseph’s Hospital in Atlanta tracks readmissions...

• Brand preservation: Part A in skilled nursing facilities

  The formulary savings table (below) is an example of how Omnicare® promotes its formulary and...

• Outcomes-based contracting case studies

  CIGNA and Merck have an outcomes-based pilot you may have heard about in which the insurer pays...

• Medical home pilots, PDL changes, and local DM programs

  If a medical home pilot in Illinois is successful in enhancing care and helping control costs, it...

Issue 36, November 6, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Trends: PCPs putting mail-order fill decision in patients’ hands

  Two hundred twenty-six out of 752 primary care physicians (PCP) and internists that MRAW polled...

• Regence site averages 2,000 member messages

  Could Regence BlueCross BlueShield’s social Web site for members provide market intelligence...

• From the editor: Payer insight links

  I wrote a few stories recently that I’ve reported in pieces here, related mostly to...

• ASP: Is there an ideal reimbursement rate?

  There may be more incentive under an average sales price (ASP) reimbursement model to prescribe...

Issue 35, October 30, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Conversation: Payers may forgo PA restrictions in more collaborative model

  Even if the products you support are orals for cardiovascular conditions, the following may be...

• Physicians lack pharmacogenomic training

  Although 98% of physicians agree that knowing a patient’s genetic profile may help them...

• Nebraska P&T lifts fail-first policies

  Nebraska Medicaid’s P&T reclassified galantamine to preferred among cholinesterease...

• Going beyond the contract: Employer benefit managers Mercer, Gallagher open up about pharmacy benefits, design, and unmet needs

  Editor’s note: We spoke with employer benefit managers for this story and include two...

Issue 34, October 9, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Employer medical director focuses on wellness, dollars saved, productivity

  Larry Catlett, MD, who serves as medical director for Cianbro, one of the East Coast’s...

• Formulary changes to consider in emerging trend

  In a study to be published later this year, hospitals interviewed have adjusted their formularies...

Issue 32, September 25, 2009

• Medication management at discharge takes back seat

  Health plans won’t love this: St. Joseph’s Hospital in Atlanta tracks readmissions...

• Brand preservation: Part A in skilled nursing facilities

  The formulary savings table (below) is an example of how Omnicare® promotes its formulary and...

Issue 31, September 18, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Brand preservation: Part A in skilled nursing facilities

  The formulary savings table (below) is an example of how Omnicare® promotes its formulary and...

Issue 30, September 14, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Adherence escalating as problem in transitions

  What’s the script trail from hospitals? Some of you have asked whether hospitals generate...

• Mercer, Gallagher open up about pharmacy benefits, design, and unmet needs in DM

  Editor’s note: This article features interviews with employer benefit managers (EBM...

• Could fewer formulary restrictions across settings reduce readmissions?

  MRAW asked skilled nursing facilities and hospitals this summer as part of a transition of care...

• Outcomes-based contracting case studies

  CIGNA and Merck have an outcomes-based pilot you may have heard about in which the insurer pays...

Issue 28, September 4, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• RN group expands as viable managed market target

  The three major nurses’ organizations in the country have come together to form the largest...

• Mercer, Gallagher open up about pharmacy benefits, design, and unmet needs in DM

  Editor’s note: This article features two interviews in my series with employer benefit...

• Could fewer formulary restrictions across settings reduce readmissions?

  We asked skilled nursing facilities and hospitals this summer as part of a transition of care study...

Issue 27, August 8, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Employer benefit manager talks about customer approach to pharmacy

  Wyndham Hotels had a minus 3% drug spend last year, a sharp contrast to most employers who...

• Home health underutilizing billable service

  There’s a managed markets opportunity in home health to carve out a leadership role...

Issue 26, August 26, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Employer adds universal step restrictions in September, more drug classes to be hit

  To continue providing what it says is affordable access to prescription drugs, Principal Life...

• Part D admin costs 11% of total drug spend

  Private Medicare Part D plans average 11.3% in administrative costs as a share of total drug...

• Managed markets program asks payer MDs to talk business during clinical meeting

  Editor’s note: A view from a health plan medical director on a difficult category was...

• Account focus: Evercare clinical team has eye on coverage gap

  I recently sat down to speak with Evercare’s clinical leadership team to hear about its...

Issue 25, August 12, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Payers weigh in on comparative effectiveness

  The buy-and-bill compensation model of drugs doesn’t lead to the best incentives for...

• How PDL committee tracks prior authorization trends

  The chart below illustrates the number of prior authorizations (PA) approved by month in Louisiana...

• Emerging trend: MD salaries, physician shift, and what to do about it

  More physicians will become employed at hospitals and change the face of medical staffs.

• Conversation: Plans looking to align reimbursement incentives based on pathway compliance

  CareFirst of Maryland is likely to reimburse oncologists at an average sales price (ASP) plus 20...

Issue 24, July 29, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Beyond the contract: Can habit-changing service affect script, formulary decisions?

  Minus a first-line drug, what we’re all trying to achieve here is brand differentiation. The...

• Home health segment focuses on QI teams

  In a survey of 324 home health agencies, including the top organizational chains (see chart on p...

Issue 23, July 15, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Infusion reimbursement drop would shift Medicare patients to hospitals

  If Medicare has its way, it will eliminate all the gains achieved several years ago in infusion...

• Greater payer MTM investment, reimbursement presents opportunities to make claims about drug profile

  As you may know, Medicare Part D MTM programs are changing again for 2010 to include more patients...

• Reducing readmission: Can your products align with payer, hospital financial goals?

  Reducing hospitalizations is one of the top benefits that plan medical directors look for when...

• Access to meds difficult for Medicaid

  Medicaid’s cumbersome policies often lead to patients not getting or filling their...

Issue 22, July 8, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Readmission data can inform formulary decisions

  I’m toiling away in the field this week on a tracking study regarding readmissions involving...

• Conversation: Commercial policies, economy affect site of care

  Urban medical and academic centers are concerned that the economy and/or job loss has forced people...

Issue 21, June 24, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• LTC: Frontline staff members take larger role in product selection

  If you market or sell to the LTC segment (or if you’re considering this), be advised...

• Mass ranks first in routing prescriptions electronically

  Massachusetts ranks first in the nation in sending more than 6.7 million prescriptions...

• Account manager insight: Facilitating C-suite quality initiatives

  As more hospitals cut their budgets, account managers and brand teams focused on these institutions...

• Conversation: Commercial policies, economy affect site of care

  Urban medical and academic centers are concerned that the economy and/or job loss has forced people...

Issue 20, June 17, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Specialty: UK group continues to influence local managed care discussions

  The National Institute for Health and Clinical Excellence (NICE) continues to be an important...

• ‘Similarly effective’ could be new standard in Medicaid

  Medications that are similarly effective will be preferred for Connecticut Medicaid’s nearly...

• C-suite group offers payment reform idea

  A group of healthcare CEOs, including a representative from Merck, urged Congress June 12 to move...

• High OOP likely behind decline-to-fill rates for MS

  One in four multiple sclerosis (MS) patients are declining to fill their prescriptions, likely due...

Issue 19, June 10, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Where do your products fit within a comparative effectiveness policy?

  To date, comparative effectiveness (CE) hasn’t been focused on oncology or other specialty...

• Rebates please

  Private health insurance leaders are pushing Congress to allow insurers to benefit from the...

• Achieving better quality with less money

  Maybe it’s the fact that access to doctors is down. Maybe it’s that the economy has...

Issue 18, June 3, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Copay assistance, patient balances up in downturn, but long-term payer contracts are greater concern

  Although there haven’t been significant average sales price/average wholesale price...

• NAMs-RAMs-CAMs: Are you engaging plans that have taken DM in-house?

  Editor’s note: Many plans, as discussed in the “How far to push, how much to...

Issue 17, May 27, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Family influence heightened during clinical meetings

  On the weekends, I’ve been doing some social work in nursing homes and acute care settings...

• How far to push, how much to pull?

  Once you have managed care’s attention about your product, what can you do to ensure a...

• NAMs: Making your value case on the road

  Healthcare formulary decision-makers will increasingly review whether they can divide populations...

Issue 16, May 20, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Economy affects dosing decisions, trickles across sites

  The weakened economy has begun to affect treatment decisions in a new way. Hospitals have begun to...

• Blocking access: Closed formulary article generates more discussion

  Editor’s note: We received requests to rerun the closed formulary article in MRAW to see...

• Women face access barriers

  If you have products geared to or indicated to treat women, you may consider how your educational...

Issue 14, April 29, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Part D plans likely to use prior authorization following Medicare policy

  Managed care readers have confirmed our report from the April 22 MRAW about how Part D plans will...

• CIGNA cost of care

  Will a new cost-of-care calculator change product selection decisions? The tool is now available to...

• Messaging to case managers should address integrated models

  Editor’s note: Case managers in the acute care setting are becoming more involved with...

• The business of LTC: LTC affects product selection, site-of-care decisions

  Various LTC-setting billing policies can affect what patients take for medications as they move...

Issue 12, April 17, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

Issue 11, April 1, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

Issue 10, March 25, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

Issue 9, March 11, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

Issue 8, February 25, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

Issue 7, February 18, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

Issue 6, February 11, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

Issue 5, February 4, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

Issue 2, August 5, 2009 - VIEW THE FULL ISSUE | A PDF OF THE FULL ISSUE

• Beyond the contract: Can habit-changing service affect script, formulary decisions?

  Minus a first-line drug, what we’re all trying to achieve here is brand differentiation. The...

• Home health segment focuses on QI teams

  In a survey of 324 home health agencies, including the top organizational chains (see chart on p...

• Conversation: Commercial policies, economy affect site of care

  Urban medical and academic centers are concerned that the economy and/or job loss has forced people...

• Account manager insight: Facilitating C-suite quality initiatives

  As more hospitals cut their budgets, account managers and brand teams focused on these institutions...

• LTC: Frontline staff members take larger role in product selection

  If you market or sell to the long-term care (LTC) segment (or if you’re considering this...