focus[ing] on doing a good job at insurers' core business. "You have to meet peoples' basic needs," Lindberg explained. For insurers, that means they can't start trying to delight consumers if they're not even paying claims in a timely manner. "Just pay the claim," she said, and then insurers can enhance the consumer experience after they meet that baseline.
For example, instead of simply denying a claim or request from a consumer for a medical service, they could suggest another possibility. They could say, "'You can have this instead' or 'Did you know this service could save you money?'" Lindberg said. The most important part is that insurers must "remove 'no' from the vernacular."Ms. Lindberg also "has banned all acronyms, industry jargon and anything over a 5th-grade reading level from all internal and external communications at Prime Therapeutics."
AIS Health discussed on a recent Magellan Rx annual drug trend report Magellan Rx notes that injectable drugs are increasingly being administered at hospitals rather than at doctors offices or other lower priced facilities.
Of the top 10 medical benefit drugs based on spend, seven have seen an increase in hospital administration between 2009 and 2012, while two have seen decreases and one has remained the same. The No. 1 drug, Remicade (infliximab), shifted from a 23% hospital infusion rate in 2009 to a 32% rate in 2012. During that four-year period, Remicade’s total per-claim cost rose from $3,711 to $4,389. Herceptin (trastuzumab), the No. 7 drug, saw its hospital administration more than double, from 23% to 49%, with the cost per claim rising from $2,562 to $3,301. Five drugs — Neulasta (pegfilgrastim), Rituxan (rituximab), Eloxatin (oxaliplatin), Herceptin and Alimta (pemetrexed) — experienced double-digit increases.AIS explains that
As a result, Magellan Rx Management recommends a variety of strategies when it comes to managing the utilization of hospital outpatient facilities for medical pharmacy products. Some of the tactics it has developed with its medical pharmacy customers are to:
- Change reimbursement in the hospital outpatient facility to be based on a drug pricing benchmark, such as average sales price or average wholesale price.
- Change benefit design so that the member’s out-of-pocket incentive aligns with the plan’s network strategy.
- Preserve office-based community providers through shared savings or innovative payment models.
- Include hospital outpatient facilities in utilization management programs and enforce the site of service policy upfront during the drug prior authorization process to assign the physician office or home as the rendering provider.
- Implement a program to help members understand their benefits by site of service and choose a lower cost, convenient site for their injectable administration.
Finally speaking of drugs the WSJ's Pharmalot blog reports that the State of Oregon is trying to go slow on covering the Solvadi hepatitis C pill. The article notes that
In this year’s first quarter, for instance, the drug generated $2.3 billion in revenue. Wall Street analysts say prescriptions have slowed more recently because they expect Gilead to launch a more potent, all-oral combination treatment this fall and physicians have, for now, delayed prescribing to new patients, a practice known as warehousing. * * *
Meanwhile, several other drug makers are racing to develop their own treatments – AbbVie, Bristol-Myers Squibb, Johnson & Johnson and Merck, which earlier this week agreed to pay $3.85 billion for Idenix Pharmaceuticals in hopes of catching up to Gilead. But whether any of these companies will attempt to trigger a price war remains to be seen.Time will tell.