TriState | Spring | 2008 | Health Plan Analysis

New York's proposal to curb "fourth tier" drug pricing has health plans alarmed that lawmakers might curb their ability to structure health benefits, particularly in cost-sharing for expensive medicines. Electronic prescribing has brought a new tool to health plans' efforts to keep members on essential medications, and Horizon's e-prescribing data suggests the problem of non-compliance with heart meds is much worse than previously thought. Emerging research is serving as a wake-up call to health plans. New York's statewide, $10 million pay-for-performance program is designed to change physician behavior towards ten long-accepted benchmarks for quality care, along with a second quality reporting program sponsored by the New York Business Group on Health. In Connecticut, health plans are battling a measure that would allow municipalities, government contractors, nonprofits and small businesses to join the state employee health plan. At the same time, the state is having trouble finding health plans that want to bid on its new combined Medicaid and low-cost insurance plan for the uninsured. And HMOs are not extinct in New York-Aetna has just birthed a new one.