Mari Edlin
Mari Edlin is a frequent contributor to Managed Healthcare Executive. She is based in Sonoma, California.
Managed care saves budgets in prison facilities
California has adopted some managed care principles, hoping to achieve accessible, cost-effective care.
Plans scramble to optimize shifting generic drug costs
This year might be remembered for its generic pipeline, with as many as 37 drugs coming off patent.
Orphan drugs target smaller populations with rare conditions
FDA-approved orphan drugs prompt plans to identify members.
Preferred networks must offer adequate member access
There are a growing number of pharmacy network designs that include member savings for using "preferred" pharmacies, in addition to the savings gained from using "preferred" drugs
Specialty tier falling out of favor because of access issues
Introducing a specialty drug tier to the formulary raises a red flag on access issues.
Investing in providers
Large health insurers are expanding, diversifying and strategically acquiring on the provider side
Without a team of pharmacists, your ACO will be incomplete
Perhaps the tide will turn as accountable care organizations and patient-centered medical homes make inroads.
Premium variation remains wide among small groups as costs rise
Premiums for small group insurance fall as size increases and companies gain economies of scale.
Drug discount cards might work against payers' programs
Drug discount programs for consumers can drive high costs.
Health plan collaboration helps advance e-Rx initiatives
The Hitech Act of 2009 provides the requirements for meaningful use of an electronic health record, including transmitting 40% of prescriptions electronically.