Thursday, December 22, 2011

Mid week update

The news that today is the FEHBlog's birthday has been eclipsed by the Hill report that
A House GOP leadership aide told The Hill that Speaker John Boehner (R-Ohio) and Senate Majority Leader Harry Reid (D-Nev.) reached an agreement to pass a version of the Senate’s two-month payroll tax cut legislation, with a fix demanded by Republicans to make implementation easier. 
This means that the temporary Medicare Part B doctor reimbursement fix also is in this bill which avoids a lot of headaches for the healthcare industry, including FEHB plans.

Another looming deadline is the conversion to the ANSI X 5010 electronic transaction standards for health care transaction purposes under HIPAA. Health Data Management reports that
The Medical Group Management Association is calling for a contingency plan of at least six months for the transition to the HIPAA 5010 transaction sets, which has a compliance date of Jan. 1, 2012. Under the plan, health plans would continue to accept Version 4010 transactions and adjudicate 5010 transactions that lack all required data. The association, which regularly surveys members and has previously warned that physicians and much of the industry remain unprepared for 5010, says federal officials need to expand the current contingency plan. The Centers for Medicare and Medicaid Services in November announced a 90-day grace period for enforcement of 5010.
This conversion sets the stage of the ICD-10 conversion. The American Medical Association recently announced its belated opposition to this ICD-10 conversion. Good luck with that.

Speaking of exercises in futility, Business Insurance reports that the Medco shareholders have approved the company's acquisition by Express Scripts. Considering how the Administration squashed the T-Mobile / AT&T deal, the FEHBlog will be surprised if this PBM deal survives anti-trust scrutiny. But stranger things have happened. Business Insurance notes that
Medco shares trade at a roughly 17% discount to the offer price, reflecting caution about the deal's ultimate approval, but that spread has narrowed in recent months.
Finally, while Houses of Congress have resolved their spat, the New York Times reports that
Barring a last-minute agreement, the [contractual] relationship between the pharmacy benefits manager Express Scripts and the major pharmacy chain Walgreens] will end Jan. 1. Customers covered by an Express Scripts prescription plan will then face the choice of switching to another pharmacy or paying for their drugs out of their own pockets if they stay at Walgreen.
Walgreen has made a major push to get health plans and employers to end relationships with Express Scripts and contract directly with Walgreen. The drugstore chain said more than 100 health plans, employers and other clients had either changed benefit managers or taken steps to maintain access to Walgreens pharmacies in 2012. But some major clients, including the health insurance giant Wellpoint and the military’s Tricare plan, stuck with Express Scripts.
Meanwhile, Walgreen rivals like CVS Caremark and Wal-Mart have been marketing aggressively, including running radio ads, to woo its customers. A CVS spokeswoman said the pharmacy chain expected to pick up 20 million prescriptions managed by Express Scripts in 2012 that were previously filled by Walgreen.       

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