Quote of the Day

“Last year, it was a competitive advantage to have this integration [between federally facilitated exchanges and the Web portals of health insurers and exchange operators]. But health plans aren’t seeing it as a competitive advantage anymore....They’re seeing it as something they have to do.”



— Toby Rogers, a managing partner at LinkedHealth, told AIS’s Inside Health Insurance Exchanges.

According to a recent analysis of the costs and characteristics of state employee health plans nation-wide in 2013:

• All together, states spent about $31 billion to insure 2.7 million employee households
• The average per-employee per-month premium for employees’ and dependents’ coverage was $963
• On average, states paid $808 (84%) of the total health plan premium, and employees covered the remaining $155 (16%)
• On average, employees paid an additional $70 per month in cost-sharing elements such as deductibles, copayments, and coinsurance
• State health plans covered an average of 92% of enrollee's healthcare costs
• 76% of state employees enrolled in plans with an annual deductible of less than $500
• 29 states enroll pre-65 retirees in health plans at the same premium rate as active employees

Source: "Report: State Employee Health Plan Spending," The PEW Charitable Trusts, August 12, 2104, http://www.pewtrusts.org/en/research-and-analysis/reports/2014/08/state-employee-health-plan-spending

Medicare Part D Enrollment and Plan Availability

According to a recent report by the Kaiser Family Foundation:

• >37 million Medicare beneficiaries are enrolled in a Part D plan (PDP or MA-PD).
• 75% of Medicare beneficiaries in California, New York, and Ohio are enrolled in Part D.
• 38% of Medicare beneficiaries in Alaska are enrolled in Part D.
• 62% of Part D enrollees nationwide are in PDPs.
• 38% are in MA-PDs nationwide.
• 1 out of 4 PDPs that participated in Part D in its first year (2006) are still in the market today.

Source: Kaiser Family Foundation

Today's Datapoint

Fewer than 50% of all Part D beneficiaries who are eligible for medication therapy management programs actually receive such services, according to new research from Avalere Health LLC.

Quote of the Day

“Whether in a bronze or copper plan [were it to be adopted], you are going to be paying pretty high cost sharing, either 40% or 50%. So for many people a $6,000 deductible — well, you might as well ask them to fly to the moon. They are banking on the fact that they will never get sick.”

— Sabrina Corlette, a research professor at the Health Policy Institute at Georgetown University, told AIS’s Health Plan Week.

Today's Datapoint

$5.5 billion ... in employer mandate penalties could be avoided were copper plans — which might on average cost 18% less than bronze plans — to be adopted for public exchanges, since businesses would be likely to enroll employees in copper plans instead of paying ACA penalties for not offering coverage, according to a new analysis by Avalere Health LLC for the Council for Affordable Health Coverage.

Quote of the Day

"Generic inflation will force payers to rethink their formulary strategies. The priciest generic drugs are still less expensive than brands. However, these products have exploded in price due to shortages, which leads to generic-to-brand substitution. Some older brand-name drugs are experiencing a sales boost from the combination of high generic prices and shortages.... Generic price increases are inflaming the already-tense relationships between pharmacies and PBMs. Pharmacies believe that PBMs are not reimbursing at current market rates. PBMs should be concerned, because pharmacy owners are successfully lobbying for new restrictions on PBM pricing flexibility and MAC transparency state laws."



— Adam Fein, Ph.D., president of Pembroke Consulting, Inc., in an interview with AIS’s Drug Benefit News following his firm’s recent analysis of July NADAC data posted on his Drug Channels blog.