Plan Design Considerations for Self-Funded Employers
Unlike insurers whose plans must comply with strict metal tier and essential health benefit requirements, self-funded groups benefit from flexibility of plan design and offerings. However...
Unlike insurers whose plans must comply with strict metal tier and essential health benefit requirements, self-funded groups benefit from flexibility of plan design and offerings. However...
To achieve savings benefits from the coming wave of biosimilars, biosimilars must be adopted by prescribers, members, and payers (through their formulary strategies). While previous...
Once the first Humira biosimilar, Amjevita, launched in the United States in January, payers needed to begin making decisions about coverage not only for Amjevita but for all the other Humira...
Health insurers are required to hold minimum levels of surplus each year. However, the exact amount a health insurer chooses to hold can vary significantly from one insurer to the next...
There is a coming wave of changes arriving soon to the pharmacy market in the form of biosimilars. And that coming wave has a big event in 2023: the launch of Humira biosimilars, which...
About 30 years ago I met with my then-business partner to think into the future and try to anticipate what we might see in terms of changes in the healthcare system. The results of this challenging process were...
Today is the day! The Big Event of 2023 is the launch of multiple Humira biosimilars which begins today with the arrival of Amgen’s Amjevita on the market. The launch of Amjevita is the first step in the Big Event...
Aligning capitation rates with the line of business and risk selection of attributed members is an important component of provider contracting. Furthermore, doing so can illuminate hidden dynamics in financial...
Although there are many variables influencing healthcare costs, the most important are unit cost and utilization. Unit cost is subject to many constraints in relation to both healthcare and the broader...
I read the 725-page draft of the Deficit Reduction Act[1] so you don’t have to. Well, I skimmed 427 pages of it while focusing on the 164 pages which make significant changes to prescription drugs. This article outlines...