Click here to close now.

Welcome!

News Feed Item

Health Exchanges Drive Change In MCO Strategies And Physician Prescribing Decisions; Impact On Pharma Mixed

Commercial Opportunities and Hurdles Discussed in New Decision Resources Group Executive Briefing

BURLINGTON, Mass., July 31, 2014 /PRNewswire/ -- Decision Resources Group's experts are scoping healthcare funding changes brought about by the Affordable Care Act (ACA), which has affected both reimbursement and prescribing of pharmaceutical therapies. The ACA altered how Managed Care Organizations (MCOs) cover beneficiaries through new regulations and expanded access via government-supported programs. Dynamic change is occurring in the health exchanges—state-based marketplaces set up by states or the federal government that allow individuals to shop for subsidized coverage—where benefit design and physician behavior result in an altered prescribing environment. A new Executive Briefing examines the key trends driven by the launch of health insurance exchanges and how they will impact the pharmaceutical industry over the next few years.

Decision Resources Group Logo.

Key Facts

  • Decision Resources Group's newest Executive Briefing, entitled Health Exchanges: What This New Channel Unlocks for Branded Agents, highlights the motivations of MCOs operating in the health insurance exchanges and outlines how their decisions affect prescribing and uptake.
    • MCOs are increasingly participating in the exchanges. Some MCOs that sat out 2014, such as UnitedHealthcare, indicated they may be entering the market for 2015.
    • MCOs are leveraging narrow networks. In a survey of 40 MCO pharmacy and medical directors that employ narrow networks, 65 percent cited the desire to reduce drug costs and 58 percent pointed to reducing medical costs as the key drivers.
    • At least in the exchanges, the era of open formularies appears to be closing. In a recent survey of 44 MCOs that offer products on the exchange, fewer than half offered an open formulary—choosing instead either a closed, or partially closed, formulary.
    • MCOs are placing higher out-of-pocket costs on exchange-based plans. Individuals covered by exchange-based plans are likely facing a deductible of at least $1,500. Surveyed plans with a deductible reported deductibles ranging from $1,600 to nearly $2,000 for an individual based on the value of the plan.
    • Physicians will react to higher cost shares by prescribing lower cost drugs, hurting branded agents. With electronic health records systems and e-prescribing, physicians understand patient formularies better than before.
  • To download the Executive Briefing, click here.

Quote

  • Roy Moore, Principal Director at Decision Resources Group, comments: "Health insurance exchanges represent the biggest opportunity for the drug industry since the launch of Part D a decade ago, but this new market is not without challenges. Health plans' desire to control cost and utilization has resulted in new hurdles to access, which ultimately affect the actual drug prescribed. Drug firms must understand the intricacies of specific exchange-based plans to devise successful strategies that will work in this new channel."

About Physician & Payer Forum: Understand Healthcare Reform's Impact by Therapy

Decision Resources Group conducts primary research with physicians, MCO pharmacy directors and MCO medical directors—and leverages expert analysis—to find unique insights.

2014 coverage includes the following titles:

Find out more about Physician & Payer Forum here.

About Decision Resources Group

Decision Resources Group offers best-in-class, high-value information and insights on critical issues within the healthcare industry. Clients rely on this analysis and data to make informed decisions. Find out more at www.DecisionResourcesGroup.com.

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.

For more information, contact:
Chris Comfort
Decision Resources Group
781-993-2597
[email protected]

Logo - http://photos.prnewswire.com/prnh/20130103/MM36768LOGO

SOURCE Decision Resources Group

More Stories By PR Newswire

Copyright © 2007 PR Newswire. All rights reserved. Republication or redistribution of PRNewswire content is expressly prohibited without the prior written consent of PRNewswire. PRNewswire shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.

Latest Stories
DevOps is about increasing efficiency, but nothing is more inefficient than building the same application twice. However, this is a routine occurrence with enterprise applications that need both a rich desktop web interface and strong mobile support. With recent technological advances from Isomorphic Software and others, it is now feasible to create a rich desktop and tuned mobile experience with a single codebase, without compromising performance or usability.
Containers are revolutionizing the way we deploy and maintain our infrastructures, but monitoring and troubleshooting in a containerized environment can still be painful and impractical. Understanding even basic resource usage is difficult – let alone tracking network connections or malicious activity. In his session at DevOps Summit, Gianluca Borello, Sr. Software Engineer at Sysdig, will cover the current state of the art for container monitoring and visibility, including pros / cons and liv...
SYS-CON Media announced today that CloudBees, the Jenkins Enterprise company, has launched ad campaigns on SYS-CON's DevOps Journal. CloudBees' campaigns focus on the business value of Continuous Delivery and how it has been recognized as a game changer for IT and is now a top priority for organizations, and the best ways to optimize Jenkins to ensure your continuous integration environment is optimally configured.
The 4th International Internet of @ThingsExpo, co-located with the 17th International Cloud Expo - to be held November 3-5, 2015, at the Santa Clara Convention Center in Santa Clara, CA - announces that its Call for Papers is open. The Internet of Things (IoT) is the biggest idea since the creation of the Worldwide Web more than
SYS-CON Events announced today that ProfitBricks, the provider of painless cloud infrastructure, will exhibit at SYS-CON's 17th International Cloud Expo®, which will take place on November 3–5, 2015, at the Santa Clara Convention Center in Santa Clara, CA. ProfitBricks is the IaaS provider that offers a painless cloud experience for all IT users, with no learning curve. ProfitBricks boasts flexible cloud servers and networking, an integrated Data Center Designer tool for visual control over the...
"In the IoT space we are helping customers, mostly enterprises and industry verticals where time-to-value is critical, and we help them with the ability to do faster insights and actions using our platform so they can transform their business operations," explained Venkat Eswara, VP of Marketing at Vitria, in this SYS-CON.tv interview at @ThingsExpo, held June 9-11, 2015, at the Javits Center in New York City.
The most often asked question post-DevOps introduction is: “How do I get started?” There’s plenty of information on why DevOps is valid and important, but many managers still struggle with simple basics for how to initiate a DevOps program in their business. They struggle with issues related to current organizational inertia, the lack of experience on Continuous Integration/Delivery, understanding where DevOps will affect revenue and budget, etc. In their session at DevOps Summit, JP Morgenthal...
"We provide a web application framework for building really sophisticated web applications that run on a browser without any installation need so we get used for biotech, defense, and banking applications," noted Charles Kendrick, CTO and Chief Architect at Isomorphic Software, in this SYS-CON.tv interview at @DevOpsSummit (http://DevOpsSummit.SYS-CON.com), held June 9-11, 2015, at the Javits Center in New York
In his session at 16th Cloud Expo, Simone Brunozzi, VP and Chief Technologist of Cloud Services at VMware, reviewed the changes that the cloud computing industry has gone through over the last five years and shared insights into what the next five will bring. He also chronicled the challenges enterprise companies are facing as they move to the public cloud. He delved into the "Hybrid Cloud" space and explained why every CIO should consider ‘hybrid cloud' as part of their future strategy to achie...
"Plutora provides release and testing environment capabilities to the enterprise," explained Dalibor Siroky, Director and Co-founder of Plutora, in this SYS-CON.tv interview at @DevOpsSummit, held June 9-11, 2015, at the Javits Center in New York City.
DevOps tends to focus on the relationship between Dev and Ops, putting an emphasis on the ops and application infrastructure. But that’s changing with microservices architectures. In her session at DevOps Summit, Lori MacVittie, Evangelist for F5 Networks, will focus on how microservices are changing the underlying architectures needed to scale, secure and deliver applications based on highly distributed (micro) services and why that means an expansion into “the network” for DevOps.
"The idea of polyglot persistence is you have to apply the right database for the job - you always have to have many different databases in play. We offer that whole system as a service," explained Raj Singh, Developer Advocate for IBM Cloud Data Services, in this SYS-CON.tv interview at 16th Cloud Expo, held June 9-11, 2015, at the Javits Center in New York City.
SYS-CON Events announced today that WHOA.com, an ISO 27001 Certified secure cloud computing company, participated as “Bronze Sponsor” of SYS-CON's 16th International Cloud Expo® New York, which took place June 9-11, 2015, at the Javits Center in New York City, NY. WHOA.com is a leader in next-generation, ISO 27001 Certified secure cloud solutions. WHOA.com offers a comprehensive portfolio of best-in-class cloud services for business including Infrastructure as a Service (IaaS), Secure Cloud Desk...
SYS-CON Events announced today that Intelligent Systems Services will exhibit at the 17th International Cloud Expo®, which will take place on November 3–5, 2015, at the Santa Clara Convention Center in Santa Clara, CA. Established in 1994, Intelligent Systems Services Inc. is located near Washington, DC, with representatives and partners nationwide. ISS’s well-established track record is based on the continuous pursuit of excellence in designing, implementing and supporting nationwide clients’ ...
The Internet of Things is not only adding billions of sensors and billions of terabytes to the Internet. It is also forcing a fundamental change in the way we envision Information Technology. For the first time, more data is being created by devices at the edge of the Internet rather than from centralized systems. What does this mean for today's IT professional? In this Power Panel at @ThingsExpo, moderated by Conference Chair Roger Strukhoff, panelists addressed this very serious issue of pro...