Preliminary Results from an Analysis of Medical and Retail Rx Spending February 29, 2016
|
|
|
- Augustus Anderson
- 6 years ago
- Views:
Transcription
1 Prescription Drug Spending Trends in MN Preliminary Results from an Analysis of Medical and Retail Rx Spending ruary 29,
2 Overview Drugs spending and overall health care spending Trends in: Volume of prescriptions Volume of spending Cost per script Spending by therapeutic classes Price trends for select products Other ongoing research 2
3 Total Minnesota Health Care Spending Estimates $45 $40 Health Care Spending in Billions $35 $30 $25 $20 $15 $10 $5 $ Source: MDH/Health Economics Program, Health Care Spending and Projections in Minnesota, 2013, Legislative Report, forthcoming 3
4 Distribution of Minnesota Health Care Spending, 2013 Non-medical spending, 4.8% Other Medical Spending, Chemical 6.9% Dependency/Mental Health, 2.5% Other Professional Services, 3.4% Dental, 3.2% Uncategorized Spending, 1.4% Inpatient Hospital, 19.8% Prescription Drugs, 8.7% Outpatient, 15.0% Long Term Care (incl. Home Health), 15.4% Physician Services, 18.7% Source: MDH/Health Economics Program, Health Care Spending and Projections in Minnesota, 2013, Legislative Report, forthcoming 4
5 Trends Affecting Health Care Spending/ Projections Spending on drugs administered in medical settings play greater role Uptick in use of specialty drugs and biologics Price pressure: Generics that have been on the market Some legacy drugs for rare conditions New brand name drugs 5
6 Total Minnesota Health Care Spending Estimates and Projections $90 $80 Health Care Spending in Billions $70 $60 $50 $40 $30 $20 Estimates Projections $10 $0 Source: MDH/Health Economics Program, Health Care Spending and Projections in Minnesota, 2013, Legislative Report, forthcoming 6
7 Study Background Federal funding support from the Centers for Consumer Information & Insurance Oversight Experts from the University of MN PI: Steve Schondelmeyer PharmD PhD Employed Minnesota All Payer Claims Data (MN APCD) to take advantage of Comprehensive information for MN s population Detail on drug spending across setting, payers and drug delivery channels Additional information on the MN APCD: 7
8 Study Results 8
9 # of Claims (Millions) Number of Prescription Drug Claims in Minnesota Medical Benefit Rx Benefit 74.5 million 16.3 million 75.6 million 75.7 million 76.1 million 16.5 million 16.1 million 16.4 million 78.5 million 16.5 million million 59.1 million 59.6 million 59.7 million 62.1 million 10 - * Source: Analysis by the PRIME Institute, University of Minnesota using the Minnesota All Payer Claims Database (MN APCD) data from 2009 to 2013.
10 Spending on Prescription Drugs in Minnesota Spending in billions $8 $7 $6 $5 $4 $3 $2 Medical Benefit Rx Benefit $6.31 billion $2.14 billion $4.17 billion $6.61 billion $2.30 billion $4.32 billion $6.73 billion $2.46 billion $4.27 billion $7.09 billion $2.62 billion $4.47 billion $7.51 billion $2.77 billion $4.74 billion $1 $0 * Source: Analysis by the PRIME Institute, University of Minnesota using the Minnesota All Payer Claims Database (MN APCD) data from 2009 to 2013.
11 Million $ $450 Monthly Spending on Prescription Drugs $400 $350 $300 $250 $200 $150 $100 $50 $0 * Pharmacy Benefit Drug Spend Pharmacy Benefit Drug Spend (12 Month Rolling Average) Medical Benefit Drug Spend Medical Benefit Drug Spend (12 Month Rolilng Average) Source: Analysis by the PRIME Institute, University of Minnesota using the Minnesota All Payer Claims Database (MN APCD) data from 2009 to 2013.
12 Monthly Spending $ Average Cost per Drug Claim in Minnesota $200 $180 $160 $140 $120 $100 $80 $60 $40 $20 $0 * $/Drug Claim in Pharmacy Benefit $/Drug Claim in Pharmacy Benefit (12 Month Rolling Average) $/Drug Claim in Medical Benefit $/Drug Claim in Medical Benefit (12 Month Rolling Average) Source: Analysis by the PRIME Institute, University of Minnesota using the Minnesota All Payer Claims Database (MN APCD) data from 2009 to 2013.
13 MN Drug Spending by Therapeutic Category, 2013 $ in Millions $0 $200 $400 $600 $800 $1,000 Endocrine & Metabolic Drugs Central Nervous System Drugs Cardiovascular Agents Analgesics & Anesthetics Respiratory Agents Anti-neoplastic Agents Gastrointestinal Agents Anti-Infective Agents Miscellaneous Products Topical Products Psych & Neurology Drugs Hematological Agents Stimulants, Obesity & Anorexia Neuromuscular Drugs Genitourinary Products Biologicals Nutritional Products Bundled & Unknown Drugs * $95 million $76 million $59 million $349 million $343 million $340 million $333 million $311 million $261 million $249 million $230 million Rx Benefit (Drug $) $445 million $425 million Medical Benefit (Drug $) $545 million $515 million $510 million $791 million 2013 Total Spending on Drugs: $7.51 billion 2013 Pharmacy Benefit Drug Spend: $4.74 billion 2013 Medical Benefit Drug Spend: $2.77 billion $1,627 million Source: Analysis by the PRIME Institute, University of Minnesota using the Minnesota All Payer Claims Database (MN APCD) data from 2009 to 2013.
14 Prices for Specific Prescription Drug Product 14
15 Prescription Drug Spending in Context Prescription drugs: Essential tools in the management/treatment of illness and acute health needs Can sometimes offset considerable long-term treatment expenses Are costly to develop and produce Can be prohibitively expensive for patients Pricing is an outgrowth of patent protection ket exclusivity, presumably to support innovation/grant protection against financial risk Single drug could distress payer budgets Value-based pricing (relative benefit)? 15
16 $ Cost/Claim (30-day) $4,000 $3,500 Herceptin (trastuzumab) IV Solution 440 mg [ ] as a Medical Benefit Claim in Minnesota: 2009 to 2013 $3,513 $3,000 $2,500 $2,000 $1,500 $1,000 $500 $2, % Increase in Cost/Claim in 5 years $0 * Source: Analysis by the PRIME Institute, University of Minnesota using the Minnesota All Payer Claims Database (MN APCD) data from 2009 to 2013.
17 $ Cost/Claim (30-day) $160 $140 $120 $100 $80 $60 $40 $20 Prevnar (pneumococcal 13-Valent Conjugate) Vaccine [ ] as a Medical Benefit Claim in Minnesota: 2009 to 2013 $ % Increase in Cost/Claim in 4 years $152 $0 * Source: Analysis by the PRIME Institute, University of Minnesota using the Minnesota All Payer Claims Database (MN APCD) data from 2009 to 2013.
18 $ Cost/Claim (30-day) $1,200 $1,000 $800 Humulin R U-500 (concentrated) [ ] as a Pharmacy Benefit Claim in Minnesota: 2009 to % Increase in Cost/Claim in 5 years $1,016 $600 $400 $301 $200 $0 * Source: Analysis by the PRIME Institute, University of Minnesota using the Minnesota All Payer Claims Database (MN APCD) data from 2009 to 2013.
19 $ Cost/Claim (30-day) $250 Doxycycline Hyclate Tablets 100 mg [ ] as a Pharmacy Benefit Claim in Minnesota: 2009 to 2013 $200 $ % Increase in Cost/Claim in 5 years (& 1811% in 1 year) $181 $100 $50 $0 * $ Source: Analysis by the PRIME Institute, University of Minnesota using the Minnesota All Payer Claims Database (MN APCD) data from 2009 to 2013.
20 $ Cost/Claim (30-day) $35,000 Actimmune (interferon gamma-1b 100 mcg/0.5 ml) [ ] as a Pharmacy Benefit Claim in Minnesota: 2009 to 2013 $30,000 $25,000 $20,000 $15,000 $10, % Increase in Cost/Claim in 5 years $20,397 $5,000 * $0 $3, Source: Analysis by the PRIME Institute, University of Minnesota using the Minnesota All Payer Claims Database (MN APCD) data from 2009 to 2013.
21 $ Cost/Claim $180 $160 $140 $120 $100 EpiPen Jr. 2 pak (Epinephrine Soln Auto-injector, 0.15 MG/0.3ML) [ ] as a Pharmacy Benefit Claim in Minnesota: 2009 to % Increase in Cost/Claim in 5 years $161 $80 $60 $56 $40 $20 $0 * Source: Analysis by the PRIME Institute, University of Minnesota using the Minnesota All Payer Claims Database (MN APCD) data from 2009 to 2013.
22 Next Steps Summarize findings to date and upcoming work in a series of issue papers and data reports Characterize trends on drug use and expenditures also by: Role of brand & generic drug products Role of specialty drugs Settings for providing drugs Source of payment for prescription drugs If authorized, update analysis through 2014 and
23 Contact Information MDH Health Economics Program Minnesota All Payer Claims Data (MN APCD) Minnesota Health Care ket Statistics Contacts Stefan Gildemeister
Chartbook Section 1. Minnesota Health Care Spending and Cost Drivers
Chartbook Section 1 Minnesota Health Care Spending and Cost Drivers Section 1: Minnesota Health Care Spending and Cost Drivers Minnesota health care spending by source of funds Minnesota health care spending
Reflection on Federal Health Reform MN Economics Association, October 27, 2017
Reflection on Federal Health Reform MN Economics Association, October 27, 2017 Stefan Gildemeister Director, Health Economics Program October 2, 2017 Overview MN health care market pre-aca The ACA: A technocrats
Implementing Statewide Measurement on Access, Cost and Quality in MN
Implementing Statewide Measurement on Access, Cost and Quality in MN IOM Workshop on Core Metrics for the Triple Aim Irvine, CA December 05, 2012 Stefan Gildemeister, Director Health Economics Program
340B Drug Pricing Program
340B Drug Pricing Program Mary Stepanyan, PharmD Candidate 2018 University of Southern California, School of Pharmacy Pro Pharma Pharmaceutical Consultants Under the preceptorship of Dr. Craig Stern WHY
Glossary of Terms (Terms are listed in Alphabetical Order)
Glossary of Terms (Terms are listed in Alphabetical Order) Access Access refers to the availability and location of pharmacies that participate in the network that serves your pharmacy benefit plan. Acute
The U.S. Healthcare System: How Pharmacy Benefit Managers Impact Prescription Drug Use. Presented by Daniel Tomaszewski Pharmd, PhD
The U.S. Healthcare System: How Pharmacy Benefit Managers Impact Prescription Drug Use Presented by Daniel Tomaszewski Pharmd, PhD 1 Medical Vs. Pharmacy Coverage Medical Insurance Managed by an Insurance
Issue Brief June, 2009
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Health Economics Program
Rx Watchdog Report Comparative Measures of Price Change for Prescription Drugs and Other Goods
Rx Watchdog Report Comparative Measures of Price Change for Prescription Drugs and Other Goods Stephen W. Schondelmeyer PRIME Institute, University of Minnesota Leigh Purvis AARP Public Policy Institute
2015 Benefits Overview
2015 Benefits Overview ASPIRE HEALTH ADVANTAGE VALUE (HMO) BENEFIT Monthly Plan Premium Out-of-Pocket Limit (In-Network Medicare-covered benefits) Annual Part C Deductible (all services except for Prescription
2016 Benefits Overview
2016 Benefits Overview ASPIRE HEALTH ADVANTAGE VALUE (HMO) BENEFIT Monthly Plan Premium Out-of-Pocket Limit (In-Network Medicare-covered benefits) Annual Part C Deductible (all services except for Prescription
Current Trends in Rx Plan Management
Current Trends in Rx Plan Management Amy Steinkellner, Pharm.D. Vice President, Clinical Services Medco s Systemed Group Medco is a registered trademark of Medco Health Solutions, Inc. 2004 Medco Health
Prescription Drug Benefits
Stryker s healthcare plan provides benefits for covered prescription drugs, including contraceptives, insulin and diabetic supplies. Benefits are paid for covered drugs that are medically necessary for
Health Plans Dashboard
Health Plans Dashboard Q2 2015 Dashboard Summary Report A review of Inpatient, Outpatient and RX trends January 14, 2016 Prepared by HSS and Aon Hewitt Introduction This report completes the first phase
Kroll Ontrack, LLC Prescription Drug Plan. Plan Document and Summary Plan Description
Kroll Ontrack, LLC Prescription Drug Plan Plan Document and Summary Plan Description Effective December 9, 2016 Kroll Ontrack, LLC reserves the right to amend the Kroll Ontrack, LLC Health & Welfare Plan
Drug Reimbursement - Croatia. Roganovic Jelena
Drug Reimbursement - Croatia Roganovic Jelena Population: 4,292,095 (July 2017) Area: 56,594 km 2 Density: 75.8/km 2 21 counties http://www.lokalniizbori.com/wp-content/uploads/2013/04/hrvatska-%c5%beupanije.jpg;
Pharmacy Benefits. Sarkis Kavarian, PharmD Candidate 2015 Preceptor Dr. Craig Stern Pro Pharma Pharmaceutical Consultants, Inc.
Pharmacy Benefits Sarkis Kavarian, PharmD Candidate 2015 Preceptor Dr. Craig Stern Pro Pharma Pharmaceutical Consultants, Inc. 4/3/2015 Introduction Pharmacy Benefits as Riders with Vision & Dental Plans
Summary of Benefits. CareMore Care to You (HMO SNP) Available in Pima County. SB_CM_AZ_CTY Y0114_18_32747_U_023 CMS Accepted ( )
Summary of Benefits Available in Pima County SB_CM_AZ_CTY Y0114_18_32747_U_023 CMS Accepted (10012017) Introduction This is a summary of health services and drugs covered by from January 1, 2018 - December
F Y 1 8 U T I L I Z A T I O N R E V I E W 7/1/2017 TO 9/30/2017 L O C K T O N C O M P A N I E S
UNIVERSITY OF ALASKA F Y 1 8 U T I L I Z A T I O N R E V I E W 7/1/2017 TO 9/30/2017 L O C K T O N C O M P A N I E S Premera- Medical L O C K T O N C O M P A N I E S Medical Utilization % Change Norm FY17
KEEPING PRESCRIPTION DRUGS AFFORDABLE: The Value of Pharmacy Benefit Managers (PBMs)
The Texas Association of Health Plans Representing health insurers, health maintenance organizations, and other related health care entities operating in Texas. KEEPING PRESCRIPTION DRUGS AFFORDABLE: The
CMSP Data Update: Tuolumne County - December 2009
CMSP Data Update: Tuolumne County - December 2009 1. CMSP Enrollment Trends 2. Health Care Utilization Trends Data Definitions Eligibles, Enrollees, or Members: All individuals enrolled in CMSP regardless
Arkansas Medicaid Structured Data Sets
Arkansas Medicaid Structured Data Sets Arkansas Medicaid has published the following data sets on the DHS and DMS websites. These data sets are all on Excel Worksheets in Read Only format. These data sets
Prescription Drug Benefits
Stryker s healthcare plan provides benefits for covered prescription drugs, including contraceptives, insulin and diabetic supplies. Benefits are paid for covered drugs that are medically necessary for
Pharmacy Benefit Managers Overview
Pharmacy Benefit Managers Overview A Presentation to the House Health Innovation Subcommittee Mary Alice Nye, Ph.D. Health and Human Services Staff Director, OPPAGA December 6, 2017 Pharmacy Benefit Managers
Summary of Benefits. CareMore Care Access (HMO) - Medicare Only. Available in Pima County. SB_CM_AZ_CA Y0114_18_32747_U_028 CMS Accepted ( )
Summary of Benefits Available in Pima County SB_CM_AZ_CA Y0114_18_32747_U_028 CMS Accepted (10012017) Introduction This is a summary of health services and drugs covered by from January 1, 2018 - December
Health Plan Benefits and Coverage Matrix
Health Plan Benefits and Coverage Matrix THIS MATRI IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE CONSULTED FOR
Health Plan Benefits and Coverage Matrix
Health Plan Benefits and Coverage Matrix THIS MATRI IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE EVIDENCE OF COVERAGE AND PLAN CONTRACT SHOULD BE CONSULTED FOR
Blue Essentials, Blue Advantage HMO SM and Blue Premier SM Provider Manual - Pharmacy
Blue Essentials, Blue Advantage HMO SM and Blue Premier SM Provider Manual - In this Section there are references unique to Blue Essentials, Blue Advantage HMO and Blue Premier. These network specific
Study on State-based Risk Adjustment in the Individual & Small Group Market. Project Update Meeting September 22, 2015
Study on State-based Risk Adjustment in the Individual & Small Group Market Project Update Meeting September 22, 2015 1 Meeting Agenda Introductions Background on risk adjustment and legislative study
COMPLIANCE IN THE 340B DRUG PRICING PROGRAM
COMPLIANCE IN THE 340B DRUG PRICING PROGRAM Jason Atlas RPh MBA Manager, Education and Compliance Support Apexus Education and Compliance Support Team Apexus Education and Compliance Support Team 1 Objectives
Public Use Files from the MN APCD
Public Use Files from the MN APCD Minnesota Health Care Data Showcase Panel Thursday, October 27, 2016 NAHDO 31st Annual Meeting & APCD Sessions Leslie C. Goldsmith Manager, Health Care Data Service Center
Outpatient Prescription Drug Benefits
Outpatient Prescription Drug Benefits Supplement to Your HMO/POS Evidence of Coverage Summary of Benefits Member Calendar Year Brand Drug Deductible Per Member Applicable to all covered Brand Drugs, including
Overview of Coverage of Drugs Under the Medicaid Medical Benefit
Overview of Coverage of Drugs Under the Medicaid Medical Benefit June 4, 2008 Amanda Bartelme Avalere Health LLC Avalere Health LLC The intersection of business strategy and public policy Medical vs. Pharmacy
Shield Spectrum PPO Plan 1000 Value
Shield Spectrum PPO Plan 1000 Value Benefit Summary (For groups 2 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Life & Health Insurance Company Effective January 1,
The State of New Mexico Group Benefits Plan Plan Year: January December 2018 Prescription Drug Program
The State of New Mexico Group Benefits Plan Plan Year: January December 2018 Prescription Drug Program 1 Who Is Express Scripts? Express Scripts administers your prescription drug benefit and you automatically
Minnesota Health Care Spending Trends,
Minnesota Health Care Spending Trends, 1993-2000 April 2003 h ealth e conomics p rogram Health Policy and Systems Compliance Division Minnesota Department of Health Minnesota Health Care Spending Trends,
Blue Shield of California Life & Health Insurance Company
Blue Shield of California Life & Health Insurance Company Outpatient Prescription Drug Benefit Rider Insurance Certificate Outpatient Prescription Drug Benefit Summary of Benefits Insured Calendar Year
Health Care Cost Transparency in Minnesota
Health Care Cost Transparency in Minnesota Julie Sonier, President MN Community Measurement October 25, 2018 1 MN Community Measurement: Who We Are and What We Do Multi-stakeholder collaborative Activities
Central Health Medicare Plan (HMO)
Central Health Medicare Plan (HMO) MONTHLY PREMIUM, DEDUCTIBLE, AND LIMITS ON HOW MUCH YOU PAY FOR COVERED SERVICES How much is the monthly premium? How much is the deductible? Is there any limit on how
UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California Pharmacy Schedule of Benefits
CALIFORNIA UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California Pharmacy Schedule of Benefits (FOR HSA-QUALIFIED DEDUCTIBLE PLANS) Summary of Benefits Retail Pharmacy Copayment
Key Medicare Issues for Coverage and Reimbursement of Specialty Pharmaceuticals
Key Medicare Issues for Coverage and Reimbursement of Specialty Pharmaceuticals By Cindy Parks Thomas, Ph.D. A dvances in biotechnology have brought many effective new treatments for serious and debilitating
PRESCRIPTION DRUG EXPENSE BENEFIT 2019
PRESCRIPTION DRUG EXPENSE BENEFIT 2019 Welcome to the Prescription Drug benefit, administered by Express Scripts, Inc. (ESI). To receive the highest level of benefits, prescription drugs must be obtained
IMS Brogan Private Drug Plan Drug Cost Forecast Commissioned by Rx&D Canada s Research-Based Pharmaceutical Companies
IMS Brogan Private Drug Plan Drug Cost Forecast 2013-2017 Commissioned by Rx&D Canada s Research-Based Pharmaceutical Companies Overview 1. Who are Rx&D and IMS Brogan? 2. Environment 3. Background 4.
Exhibit 1. Availability of Public Information
Exhibit 1. Availability of Public Information In your view, how important do you think it is to have information about each of the following available to the public? Clinical quality health outcomes (e.g.,
Re: Medicare Prescription Drug Benefit Manual Draft Chapter 5
September 18, 2006 BY ELECTRONIC DELIVERY Cynthia Tudor, Ph.D. Director, Medicare Drug Benefit Group Centers for Medicare and Medicaid Services Department of Health and Human Services Mail Stop C4-13-01
2016 Summary of Benefits. Classic Rx (HMO)
2016 Summary of s Classic Rx (HMO) Summary Of s January 1, 2016 - December 31, 2016 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we cover, or list
Coinsurance. Once Lifetime Reserve days are used (or would have ended if used) additional 365 days of confinement per person per lifetime $0 100% $0
GROUP BENEFITS SENIOR MEDICAL INSURANCE PLAN SUMMARY OF SILVER PLAN FOR RETIREES OF: ORTHODOX HEALTH PLAN AGP-3203 THROUGH HARTFORD EMPLOYER GROUP INSURANCE TRUST (HEGIT) UNDERWRITTEN BY: HARTFORD LIFE
2016 Summary of Benefits. Preferred Rx (PPO)
2016 Summary of s Preferred Rx (PPO) January 1, 2016 - December 31, 2016 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we cover, or list every limitation
Prescription Drug Coverage
The Company s medical plans automatically include coverage for prescription drugs which is administered by Envision Pharmaceutical Services, Inc. (Envision Rx) for prescriptions filled at retail pharmacies
1/16/2014. David Pointer President, SolutionsRx
David Pointer President, SolutionsRx 417.679.2203 david@pointerlaw.com 1 340B Program Overview Physician-Administered Drugs Contract Pharmacies 340B Compliance Expanding 340B Utilization 2 Federally mandated
Medicare Part D: Better understanding the nuances of the prescription drug benefit
Medicare Part D: Better understanding the nuances of the prescription drug benefit Rajul A. Patel, Pharm.D, Ph.D. TJL School of Pharmacy & Health Sciences University of the Pacific July 26 th, 2018 Today
Blue Shield of California. Highlights: A description of the prescription drug coverage is provided separately
An independent member of the Blue Shield Association California Trucking Association Health & Welfare Trust Access+ HMO SaveNet Facility Coinsurance 25-25% Benefit Summary (For groups of 300 and above)
RAND Update on State Savings Approaches
RAND Update on State Savings Approaches Chrissy Eibner February 5, 2019 RAND is working with CHCF to describe health care savings options for CA Goal is to describe possible savings approaches and discuss
2017 Pre-Retirement Planning
2017 Pre-Retirement Planning We are expecting a large number of participants for today s program. Please help eliminate empty seats by moving to the center of your row. As a courtesy to your colleagues,
Health Plan of Marathon Oil Company Prescription Drug Program Choice Plus Traditional Option
Health Plan of Marathon Oil Company Prescription Drug Program Choice Plus Traditional Option This summary plan description constitutes part of the Health Plan of Marathon Oil Company plan document along
Lindsey Imada, PharmD Candidate 2016 Midwestern University, Chicago College of Pharmacy
Lindsey Imada, PharmD Candidate 2016 Midwestern University, Chicago College of Pharmacy Under the Preceptorship of Dr. Craig Stern Pro Pharma Pharmaceutical Consultants, Inc. September 11, 2015 S OBJECTIVES
Schedule of Benefits. Plan Information Participating Provider Non-Participating Provider. Deductible: $250 / $750 Rx: $10/$25/$40/$40 Coinsurance: 0%
Schedule of Benefits UPMC Business Advantage PPO - Premium Network Primary Care Provider: $20 Copayment per visit Specialist: $20 Copayment per visit Deductible: $250 / $750 Rx: $10/$25/$40/$40 Coinsurance:
MAHP: Who We Are. The Michigan Association of Health Plans is a nonprofit corporation established to promote the interests of member health plans.
1 MAHP: Who We Are The Michigan Association of Health Plans is a nonprofit corporation established to promote the interests of member health plans. MAHP s mission is to provide leadership for the promotion
2015 Summary of Benefits
2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3909 Y0041_H3909_PC_15_18889 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how
NEW JERSEY Aetna Individual Choice Indemnity Plans
NEW JERSEY Aetna Individual Choice Indemnity Plans Thank you for your interest in Aetna Life Insurance Company. In response to your request, we have enclosed information on Aetna s Individual Choice Indemnity
Shield Spectrum PPO Plan 750 Value
Shield Spectrum PPO Plan 750 Value Benefit Summary (For groups 2 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Life & Health Insurance Company Effective July 1, 2012
Sharp Health Plan Outpatient Prescription Drug Benefit
Sharp Health Plan Outpatient Prescription Drug Benefit GENERAL INFORMATION This supplemental Evidence of Coverage and Disclosure Form is provided in addition to your Member Handbook and Health Plan Benefits
Cody Wiberg, Pharm.D., M.S., R.Ph. Executive Director Minnesota Board of Pharmacy
Cody Wiberg, Pharm.D., M.S., R.Ph. Executive Director Minnesota Board of Pharmacy UNITED STATES MILITARY CANADIAN MILITARY Pharmacy Preferred Providers as Selected by Drug Manufacturers and Third
Additional Information Provided by Aetna Life Insurance Company
Additional Information Provided by Aetna Life Insurance Company Inquiry Procedure The plan of benefits described in the Booklet-Certificate is underwritten by: Aetna Life Insurance Company (Aetna) 151
MEDICAL SCHEDULE OF BENEFITS COPAY GOLD
LIFETIME MAXIMUM BENEFIT Unlimited CALENDAR YEAR MAXIMUM BENEFIT CALENDAR YEAR DEDUCTIBLE Single Family CALENDAR YEAR OUT-OF-POCKET MAXIMUM (includes medical Deductible, medical Coinsurance, medical Copays
Another choice is to get your Medicare benefits by joining a Medicare health plan (such as Senior Care Plus: Value Rx Plan (HMO)).
Summary of Benefits Report SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have choices about how to get your Medicare benefits One choice is to get your Medicare benefits through Original Medicare
A Basic Understanding of Medicare and Medicare Plans in 12 Questions. Understanding the Basics to Make the Best Choices
A Basic Understanding of Medicare and Medicare Plans in 12 Questions Understanding the Basics to Make the Best Choices Objective Medicare can be a Mystery. Following a Heuristic approach, the Objective
Medical Benefits Comparison Book 2018 Medicare Retirees in the Rochester Area
Medical Benefits Comparison Book 2018 Medicare Retirees in the Rochester Area Human Resources Finance & Administration Rochester Institute of Technology Medical Benefit Comparison This information provides
Health Benefits Simplified Spectrum Engineers Medical Benefits Overview
Health Benefits Simplified Spectrum Engineers Medical Benefits Overview Welcome! HealthEZ is proud to continue to serve as your benefit administrator. We help companies all over the US provide custom,
Unclassified Drugs PAYMENT POLICY ID NUMBER: Original Effective Date: 05/14/2010. Revised: 02/23/2018 DESCRIPTION:
Private Property of Florida Blue. This payment policy is Copyright 2018, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission
Additional Information Provided by Aetna Life Insurance Company
Additional Information Provided by Aetna Life Insurance Company Inquiry Procedure The plan of benefits described in the Booklet-Certificate is underwritten by: Aetna Life Insurance Company (Aetna) 151
January 1, State Notification Regarding Exchanges
January 1, 2013 State Notification Regarding Exchanges While the ACA notes implementation won t begin until January 1, 2013, states must have their health insurance exchange blueprints submitted to the
OPERATIONS BULLETIN. Date: February 13, 2015 Geisinger Gold Participating Providers Re: Geisinger Gold 2015
OPERATIONS BULLETIN Date: February 13, 2015 To: Geisinger Gold Participating Providers Re: Geisinger Gold 2015 Geisinger Gold 2015 Product Line Geisinger Gold serves more than 79,000 members in 40 counties
Member Cost Sharing Participating Provider Non-Participating Provider Annual Deductible Individual $250 $750 Family $750 $2,250
Schedule of Benefits UPMC Business Advantage PPO - Premium Network Deductible: $250 / $750 Coinsurance: 0% Total Annual Out-of-Pocket: $6,350 / $12,700 Primary Care Provider: $20 Copayment per visit Specialist:
GENERIC DRUG SAVINGS IN THE U.S.
GENERIC DRUG SAVINGS IN THE U.S. FIFTH ANNUAL EDITION: 2013 EXECUTIVE SUMMARY Generic pharmaceuticals now firmly positioned as a reliable lever to decrease healthcare costs continued to deliver outstanding
PLAN F MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD 2019
PLAN F MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD 2019 * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital
Continuum Application Statement of Health Form for Health Care and Dental Care Insurance
Continuum Application Statement of Health Form for Health Care and Dental Care Insurance Please PRINT clearly. In this application form, you and your refer to the person applying for insurance. We, us,
Summary of Benefits Community Advantage (HMO)
Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list
The 340B drug discount program was created in 1992
Proposed Rule Changes for 340B Programs: Overview and Impact Anthony Zappa, PharmD, MBA Specialty Healthcare Benefits Council The 340B drug discount program was created in 1992 as a means for certain nonprofit
CDM Registration MN APCD
CDM Registration MN APCD REGISTRATION FORM FOR THE MINNESOTA ALL-PAYER CLAIMS DATABASE (MN APCD) Welcome to the MN APCD Registration Form Welcome to the downloadable version of the registration form for
Benefit modifications for members with Full PPO /60
An independent licensee of the Blue Shield Association A17436 (01/2017) Benefit modifications for members with Full PPO 250 80/60 Effective January 1, 2017 The Full PPO 250 80/60 plan name will be changed
MEDICAL SCHEDULE OF BENEFITS COPAY GOLD
NON- LIFETIME MAXIMUM BENEFIT Unlimited CALENDAR YEAR MAXIMUM BENEFIT CALENDAR YEAR DEDUCTIBLE Single Family CALENDAR YEAR OUT-OF-POCKET MAXIMUM (includes Deductible, Coinsurance, Copays and Precertification
40% (Not subject to the Calendar-Year Deductible) CT scans, MRIs, MRAs, PET scans, and cardiac diagnostic
An independent member of the Blue Shield Association P.C. Specialists dba Technology Integration Group Custom Shield PPO Combined Deductible 30-1250 90/60 Benefit Summary (For groups of 300 and above)
BENEFITS-AT-A-GLANCE
BENEFITS-AT-A-GLANCE Plan Name: Type of Plan: PPO Network: Pre- Certification Requirements: Orange Ulster School Districts Health Plan Indemnity with PPO Benefit; No Referral Required Basic hospital benefits;
Health Care Analytics that Matter to Employers: A Case Study using the MN APCD. Stefan Gildemeister Director, Health Economics Program October 2017
Health Care Analytics that Matter to Employers: A Case Study using the MN APCD Stefan Gildemeister Director, Health Economics Program October 2017 Project Objectives Engage Minnesota employers to: Build
Another choice is to get your Medicare benefits by joining a Medicare health plan (such as Senior Care Plus: Freedom Rx Select Plan (PPO)).
SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have choices about how to get your Medicare benefits One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare).
Blue Shield 65 Plus (HMO) summary of benefits
Blue Shield 65 Plus (HMO) summary of benefits Group Medicare Advantage-Prescription Drug Plan for CalPERS retirees January 1, 2015 to December 31, 2015 Blue Shield of California is a HMO plan with a Medicare
The Health Plan has processes in place that explain how members, pharmacists, and physicians:
Introduction Overview The Health Plan shall promote optimal therapeutic use of pharmaceuticals by encouraging the use of cost effective generic and/or brand drugs in certain therapeutic classes. The Health
PLAN F MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD
PLAN F MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD - 2018 * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the
Summary of Benefits. for Anthem MediBlue Select (HMO) Available in Hartford county, CT
Summary of Benefits for Available in Hartford county, CT Anthem Blue Cross and Blue Shield is an HMO plan with a Medicare contract. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal.
Workers Compensation Board Pharmacy Benefit Plan
1.0 Introduction Workers Compensation Board Pharmacy Benefit Plan Options for pharmaceutical care have greatly expanded over the past several years. New pharmaceuticals and pharmaceutical treatment modalities
You must pay all the costs up to the deductible amount does not apply to services with a co-pay. Deductible does apply to
This is only a summary: If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.medica.com or by calling 1-855-235-0510. Important Questions
UC SHIP Premium Formulary. Effective September 1, 2016
UC SHIP Premium Formulary Effective September 1, 2016 Formulary A formulary identifies the drugs available for certain conditions and organizes them into cost levels, also known as tiers. An important
Additional Information Provided by Aetna Life Insurance Company
Additional Information Provided by Aetna Life Insurance Company Inquiry Procedure The plan of benefits described in the Booklet-Certificate is underwritten by: Aetna Life Insurance Company (Aetna) 151
MEDICAL SCHEDULE OF BENEFITS COPAY GOLD
LIFETIME MAXIMUM BENEFIT CALENDAR YEAR MAXIMUM BENEFIT CALENDAR YEAR DEDUCTIBLE Single Family CALENDAR YEAR OUT-OF-POCKET MAXIMUM (includes medical Deductible, medical Coinsurance, medical Copays and Precertification
Prime therapeutics medicare part d preferred drug list 2017
Prime therapeutics medicare part d preferred drug list 2017 Apr 28, 2018. Explore part D, part B formulary medication and non-formulary drug list.. Prior Authorization and Step Therapy criteria at Prime
PLAN F or HIGH DEDUCTIBLE PLAN F MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD
SERVICES DS-GRMSP10(46) Page 1 MEDICARE PAYS AFTER YOU PAY $2240 PLAN PAYS HOSPITALIZATION * Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1340
Chapter 21. Pharmacy Services
Last Updated: 11/14/2018 1:52:00 PM Chapter 21 Pharmacy Services Definitions Compounded Prescription: A prescription prepared in accordance with Minnesota Rules 6800.3100. Dispensing Date: The actual date
Oklahoma Health Care Authority
Oklahoma Health Care Authority It is very important that you provide your comments regarding the proposed rule change by the comment due date. Comments are directed to Oklahoma Health Care Authority (OHCA)
U of MN Elect/Essential Coverage Period: 1/1/2017 through 12/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary: If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.medica.com or by calling 952-992-1814 (Minneapolis/St.
Glossary. Adults: Individuals ages 19 through 64. Allowed amounts: See prices paid. Allowed costs: See prices paid.
Glossary Acute inpatient: A subservice category of the inpatient facility clams that have excluded skilled nursing facilities (SNF), hospice, and ungroupable claims. This subcategory was previously known