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High Unemployment Rates in North Carolina Will Continue to Dictate the Decrease of Commercial Health Plan Enrollment and the Increase of Medicaid Enrollment
Date:10/28/2010

NASHVILLE, Tenn., Oct. 28 /PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that high unemployment rates in North Carolina will continue to dictate decreasing commercial health plan enrollment rates and rising Medicaid enrollment rates. However, according to the Carolinas Health Plan Analysis, there is less state funding available to deal with increasing Medicaid enrollment.

The report finds that in order to compensate for this, the state is putting cost-saving measures in place. North Carolina has moved to decrease its drug spending by utilizing a preferred drug list, which will confine drug choices to clinically effective generics and lower-cost alternatives whenever possible. Branded drugs will only be available to recipients on a prior-approval basis. In addition, state legislators have agreed to allow the North Carolina Department of Health and Human Services to enter a multistate purchasing pool to leverage drug rebates and discounts from pharmaceutical companies.

"Compared to other states, North Carolina is late to the table with a preferred drug list," states Jan Shuxteau, market analyst with HealthLeaders-InterStudy. "Pharmaceutical companies will face barriers in the state with prior authorizations and an emphasis on generics. In addition, expect the Department of Health and Human Services to negotiate directly with pharma companies and contract with a pharmacy benefit manager for negotiated discounts and rebates."

Other topics highlighted in the recent Carolinas Health Plan Analysis include:

  • How South Carolina is responding to its increasing Medicaid enrollment.
  • Blue Cross and Blue Shield of North Carolina, the largest plan in the state, and its plan to cut administrative costs by 20 percent.
  • The move by Humana to add the Carolinas HealthCare System to its provider network.

  • Why Pharmaceutical Company Managed Markets Teams
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    SOURCE HealthLeaders-InterStudy
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