How Payers are Responding to Healthcare Reform

Read on to find out which provisions payers view as most impactful on their business. Of those plans that indicated they have begun early implementation of HCR provisions, extending dependant coverage to those up to age 26 is the most common.

Payers identified the following as the top 3 most significant changes related to the recently passed HCR legislation that are impacting their business overall:

• Elimination of pre-existing condition requirements
• Insurance mandates for individuals/employers
• Annual/lifetime limit eliminations

As a result of HCR legislation, payers will be implementing a variety of tools and tactics to better manage costs. Those identified as most likely to be implemented are:

• Closer specialty drug management
• Increases in patient premiums or deductibles
• Increased focus on quality of care
• Change in provider reimbursement structure/mechanisms
• Increases in employer costs

Many details and provisions of healthcare reform affect not only payers but also manufacturers and, thus, potentially provide collaboration opportunities. The most frequently identified areas where payers are still looking for more information about HCR’s impact on their business are of common interest to manufacturers:

• Biosimilars
• 340 B provisions (ie, drug pricing program)
• Medicare Part D changes

Xcenda can help manufacturers develop and present the value of their products and information to payers in a collaborative atmosphere, post-healthcare reform, to ensure the continued success of all stakeholders.

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1. Survey conducted with members of Managed Care Network in May 2010; N=51.