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Topic: Sales & Marketing
The Wall Street Journal reported last night (Cigna Nears Deal to Buy Express Scripts) that Cigna is in final talks to acquire Pharmacy Benefit Manager (PBM) Express Scripts (ESRX) for a whopping $67 billion. ESRX was the last truly independent major PBM, and the deal signals the end of an era…and ushers in a new one, further blurring the lines between insurers, providers, and their primary vendor. The combined entity will reach over 250 million people and will have a ripple effect on many of their competitors.
The February 2018 Medicare Advantage (MA) enrollment report is out and includes the tail end of Annual Election Period (AEP) activity.
On February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released its 2019 Advance Rate Notice (Part II) and Draft Call Letter. CMS estimates an expected increase of 1.84% to payments in 2019. CMS says its estimates do not reflect underlying coding trend, which it expects to increase risk scores by 3.1% in 2019.
As 2018 and Year 2 of the chaotic Trump Administration kick off, trying to predict what will happen in Medicare, Medicaid, and the Affordable Care Act is as challenging as ever. It’s a midterm election year with terrible headwinds for the GOP, so the legislative calendar is abbreviated, and partisan rancor will peak. That makes it less likely Republicans will get to do much damage but also more likely they will try to serve up red meat for their base, like a return to “repeal and replace.” Congressional leaders, fresh off their billionaire bailout tax bill, are already talking about taking up “reform” (aka cuts) of Medicare and Medicaid and other social welfare programs. The only thing that is certain is 2018 will be another battleground year for government health programs.
Do it now! Get your benefit strawman, enrollment projections, and financial goals developed before benefit season begins!
The 2018 “landscape files” for Medicare Advantage (MA) and Medicare Part D from The Centers for Medicare & Medicaid Services (CMS) are out, and they show the two programs as stronger than ever, and providing great value to beneficiaries. A closer look at the numbers also reveals the strategies of market leaders to get in front of two seismic events in government health programs.
Here are three planning questions you need to ask yourself right now:
- Are you losing market share because you are not offering the right products or product mix?
- How could the profitability of your Medicare Advantage (MA) enrollment change if you expanded your service area?
- Is now the time to begin offering an MA plan?