Indication-Based Formularies Are Coming in 2020

Change is in the air. Recently, the Centers for Medicare & Medicaid Services (CMS) announced it was rescinding the rule that prohibited Step Therapy for many Part B drugs beginning 2019. Now,…

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Robust MA Enrollment Numbers Signal Opportunity

Last Friday’s enrollment numbers from the Centers for Medicare & Medicaid Services (CMS) paint an exciting picture. At the market close Friday, we reached 21.44 million Medicare Advantage (MA) members—that is 35% of the entire…

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Change is Coming to Medicare Advantage Operations

“Adaptability is about the powerful difference between adapting to cope and adapting to win” is an insightful quote from Max McKeown, an English researcher on innovation strategy. The Centers for Medicare &…

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How to Avoid Network Development & Expansion Pitfalls

Network management, directory accuracy, service area expansions (SAEs), and the new triennial review process have placed many Medicare Advantage (MA) plans in flux and exposed serious issues – from policy to process…

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