The Formulary Season

Debra Devereaux

It’s the formulary season, and you should be in the home stretch for your Health Plan Management System (HPMS) submission. What’s on the formulary and what changes were made to the formulary are among the top reasons why members either enroll in or disenroll from a health plan. Manufacturer price increases over the past two years and the number of high-cost specialty drugs released to market make formulary decisions and utilization increasingly difficult and significant to the health plan’s bottom line. With an average generic medication utilization rate of 80-85%, there is limited movement to improve. Some thoughts to consider:

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How do health plans increase brand recognition and improve brand loyalty?

Carrie Barker-Settles
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Why Do We Make Simple Things So Difficult?

Aaron Eaton

Time and time again, we encounter “the coolest workarounds” ever invented within the government programs space. Said a …

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The Path to Value: The MACRA Quality Payment Program

Elena Martin

To quote Yogi Berra, “If you come to a fork in the road, take it.” Great, but exactly …

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Why are the Dual Eligible Demos Such a Hot Mess?

John Gorman

There’s no avoiding the steady stream of bad news facing the Centers for Medicare & Medicaid Services (CMS) financial alignment demonstrations …

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Tag, You’re It…RADV Selection Has Begun

Jessica Smith

The data submissions have been completed, and the Risk Adjustment Data Validation (RADV) selection process has begun. Are …

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The Effect of the New Part B Drug Payment Proposal on Medicare Advantage and Part D

Olga Walther

It’s no secret drug costs have skyrocketed in the past decade, and drug payment policymakers face an uphill …

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