The number of plan sponsors that will offer consumer-directed health plans that integrate pharmacy and medical benefits increased more than 16-fold, from 3 to 50, between January 2005 and January 2006, according to Medco Health Solutions. Medco says that the number of plan sponsors offering a pharmacy benefit in their consumer-directed health plans could reach 100 within the next 12 months.

The number of members enrolled in a CDHP with an integrated health savings account topped 2 million — more than one third of the entire U.S. CDHP market. Medco says this growth is fueled by the recent expiration of the IRS Transition Relief for HSAs. It is now required that the prescription drug benefit, along with the medical benefit, be considered as part of the high-deductible health plan.

In the past, there was a perceived lack of integration between the pharmacy and the medical side of the benefit. This is not the case anymore, according to Medco.

"The technology has advanced now to the point that we can provide real-time integrated exchange of data between the pharmacy and medical benefits," says Tracy Grunsfeld, senior director of consumer solutions at Medco. "This gives our clients the best of both worlds — a seamlessly integrated health benefit for the consumer with a continued and dedicated focus on pharmacy benefits."

Medco says that 50 percent of all health care transactions are pharmacy-related. Therefore, pharmacy provides the greatest opportunity to promote consumer-directed health plans. A well-managed pharmacy benefit is critical to a plan sponsors' efforts to involve the consumer in the health decision-making process, and requires that medical and pharmacy providers be properly managed to provide an integrated benefit.

Medco CDH client growth

Source: Medco Health Solutions

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.