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Specialty Infusion Companies fend off PBM market entry

November 25, 2009

Analysis of:Pesky Rascals | www.homeinfusionreports.com

Home infusion companies are rallying as solutions for health plans to lower medical costs with hospital providers and offer a drug delivery option over physician buy and bill practice. PBMs have noticed the attractive margins and the need to provide a delivery mechanism to benefit from the large molecule infusion drugs that await approval in the FDA pipeline.Is 2010 the year that consolidates the industry?

PBMs enter challenging times, again.

November 25, 2009

Analysis of:Caremark Tumbles on Lost Business | seekingalpha.com

CVS CEO Tom Ryan noted a difficult selling season earlier this month. Scores of contracts with health plans and employer groups worth $2 billion were not renewed. Lawsuits and a FTC investigation await.Independent PBMs like ReStat and SXC are gaining large customers with their transparent model and are eroding the BIg 3 market share. ...and health care reform?Is this market segment moving towards a dramatic correction?

Health Care Reform forcing changes with Health Plans and Specialty Infusion

November 25, 2009

Analysis of:Repackaging Your Managed Care Strategy | www.homeinfusionreports.com

With the market entry of new players including PBMs, specialty pharmacies and infusion therapy providers are reaching out to HMO and PPO health plans to present their value proposition. They are facing payors that must adapt in its most challenging economic and regulatory environment.

Express Scripts feeling Growing Pains

October 29, 2009

Analysis of:Express Scripts to Close NextRx Deal in 4Q | quicktake.morningstar.com

On 11/04/09 TriCare, the health insurance plan for the US Military and its families are being moved to a new pharmacy benefit administered by Express Scripts. Despite assurances of transparency and no change in pharmacies, thousands of beneficiaries are being directed by Express Scripts to a single option for the most expensive drugs or specialty pharmacy products. This distributor is Curascript, wholly owned by Express Scripts.

Particle Beam Radiation Therapy (PBRT) life saving technology but who will pay?

October 22, 2009

Analysis of:Particle Beam Radiation Therapy published by AHRQ | effectivehealthcare.ahrq.gov

PBRT is an exciting technology that has emerged as a life saver for children and many adults with head/neck , eye and other difficult to treat cancers. Proton Centers require massive investments from $100-250 million. Payor groups from Medicare to commercial plans are faced with whether to pay for this promising technology and what diagnoses are appropriate. This study looks at the effectiveness of PBRT vs. IMRT and other current treatment options. But can centers have an ROI on uncommon cancer?

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