Michigan | Spring | 2010 | Health Plan Analysis

The passage of the Patient Protection and Affordable Care Act will, in the short run, expand coverage for young people, create new high-risk pools, shift incentives for Medicaid drug rebates and make federal assistance available for reinsurance of early retirees. Michigan health plans find themselves in good shape, as they are already doing much of what the new law requires. The continued growth of mail-order pharmacy delivery appears anything but certain, as most insurers in Michigan have leveled the playing field between retail pharmacy dispensing and mail order. Competing forces, like retailers offering low-cost generics, health plans re-contracting with PBMs that don't give the best pricing and a broad-based push for more generic dispensing, have all worked against mail order, even though it usually offers a better deal to members and employers. Blue Cross Blue Shield of Michigan has offered a new PPO-based wellness product that takes a more aggressive approach to rewarding good health. Using a typical two-tiered benefit, it requires members to actually have better health, as documented by evidence-based measures, to qualify for lower cost-sharing.