Pennsylvania | Fall | 2009 | Health Plan Analysis

Independence Blue Cross is one of the state’s largest health insurers, but is one of the last to cover its members’ self-injected specialty drugs under the medical benefit. But that’s changing in 2010, as the Blue plan catches up to the rest of the industry by requiring those drugs to be purchased through the pharmacy system. Of the 3,200 affected customers, some will have to pay more out-of-pocket for these expensive biologics. The quest for control over limited healthcare dollars is prompting more counties to opt out of fully insured plans and take on the risk of paying medical claims. They are pooling their resources in a purchasing coalition that’s gaining momentum in the commonwealth. Talk in Washington of some big changes in store for the Children’s Health Insurance Program hasn’t deterred a couple of Pennsylvania health plans from jumping into CHIP for the first time this year: Geisinger Health Plan and Health Partners. Geisinger is also taking more of a gamble with another population: those in Medicare Advantage special needs plans. The carrier is expanding participation in the program while others are begging out in 2010 because of cost and concerns about future federal policy. Bravo Health is also making waves in the Medicare program by establishing a unique medical clinic especially for its high-risk Medicare members. A new telehealth project from UPMC aims to put the gravest heart patients at ease with round-the-clock home monitoring.

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