Pennsylvania health plans have seen great success in managing their pharmacy costs – through encouraging the use of generics, aggressive formulary management, and copay structures. But the conundrum presented by high-cost biologic specialty drugs is being met with varying approaches whose outcomes bear watching.
Small businesses in Pensylvania are seeing sharp premium increases in 2008 as more plans turn to predictive modeling to set rates. Meanwhile, the HMO appears to be going the way of the dodo in the state, as cost differentials vanish.
Meanwhile, the state of Pennsylvania is expanding its use of managed care in its Medicaid program, but has carved out its pharmacy benefit in order to capture rebate income from pharmaceutical companies. The extent to which rebate-chasing might change the state's formulary is an open question. The state is also in the midst of forming a huge new plan covering all 230,000 public school employees across the stateÂ-an action that will erase dozens of small and medium-sized accounts and combine them into one large group with a lot of market clout.