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Health Exchanges Drive Change In MCO Strategies And Physician Prescribing Decisions; Impact On Pharma Mixed
Date:7/31/2014

8212;choosing instead either a closed, or partially closed, formulary.
  • MCOs are placing higher out-of-pocket costs on exchange-based plans. Individuals covered by exchange-based plans are likely facing a deductible of at least $1,500. Surveyed plans with a deductible reported deductibles ranging from $1,600 to nearly $2,000 for an individual based on the value of the plan.
  • Physicians will react to higher cost shares by prescribing lower cost drugs, hurting branded agents. With electronic health records systems and e-prescribing, physicians understand patient formularies better than before.
  • To download the Executive Briefing, click here.
  • Quote

    • Roy Moore, Principal Director at Decision Resources Group, comments: "Health insurance exchanges represent the biggest opportunity for the drug industry since the launch of Part D a decade ago, but this new market is not without challenges. Health plans' desire to control cost and utilization has resulted in new hurdles to access, which ultimately affect the actual drug prescribed. Drug firms must understand the intricacies of specific exchange-based plans to devise successful strategies that will work in this new channel."

    About Physician & Payer Forum: Understand Healthcare Reform's Impact by Therapy

    Decision Resources Group conducts primary research with physicians, MCO pharmacy directors and MCO medical directors—and leverages expert analysis—to find unique insights.

    2014 coverage includes the following titles:


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