Managed Care - November 2008 - (Page 4)

Care Vol. 17, No. 11 November 2008 COVER STORY M A N A G E D 18 Laurie Brubaker Do It Yourself for Less 18 Why should insurers contribute to the bottom lines of PBM, DM, specialty pharmacy, and behavioral health care vendors? Some plans are taking these functions in-house, but it’s not always a good idea. Biomarkers Promise, but Do They Deliver? Expanded blood testing can reveal much about individuals’ health risks, but for the moment, it is a challenge to apply this tool at the health plan level. 25 Oncologists Complain About Drug Payment 32 25 Medicare pays the average sale price plus 6 percent. Many private payers like that formula too. However, doctors say they can’t handle it financially and are successfully passing the burden back to plans. Consider Blood Pressure Self-Monitoring 35 Many health plans are looking at ways to improve control of hypertension, and this might be a good one. Home monitoring can be a better guide than readings in a clinic. Q&A: Keep Industry in the Game 38 Martin Sepulveda, MD, the man credited with keeping IBM a health care coverage innovator, calls employers’ participation essential. DEPARTMENTS 38 Martin Sepulveda, MD New Electronic Edition This new edition looks just like the physical magazine. Search through it; use hyperlinks; download to your desktop. www.ManagedCareMag.com/ nxtbook Editor’s Memo 2 Ease burden on physicians. News and Commentary 6 Medicaid spending soars. Legislation & Regulation 8 The challenge of mental health parity. Letters 10 Medication Management 14 Pharmacists and the medical home. Compensation Monitor 17 Managed care loses some power. Formulary Files 43 Use of multitier benefit designs grows. Plan Watch 44 Addressing racial disparities. Tomorrow’s Medicine 46 Gene therapy & Huntington’s disease. Outlook 48 Fewer PDPs for seniors in ’09. Visit us online at http://www.ManagedCareMag.com/ http://www.ManagedCareMag.com/nxtbook http://www.ManagedCareMag.com/

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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