Narrow Network Strategies and Trends for Health Plans and PBMs

Narrow Network Strategies and
Trends for Health Plans and PBMs

Narrow networks — for both medical and pharmacy providers — are gradually becoming more accepted by carriers, plan sponsors and patients. Smaller provider networks allow payers to manage overall healthcare costs while still maintaining access to benefits — an important consideration as plan designs become more commoditized in the age of public and private health insurance exchanges.

Narrow Network Strategies and Trends for Health Plans and PBMsNarrow Network Strategies and Trends for Health Plans and PBMs outlines the tactics health plans are using to restrict medical and pharmacy networks while still maintaining adequate access to care and positive relationships with providers. It also summarizes case studies of health plans and PBMs that have formed narrow networks and the results they’ve seen.

Get strategies for designing benefits and avoiding potential legal hurdles when developing pharmacy and medical narrow networks in the private and public sectors.

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Table of Contents

  • Pharmacy Narrow Network Development
    • Despite Buzz, Narrow Networks Haven’t Seen Widespread Adoption, Say Experts
    • Restricted Networks Are Still Slow to Grow
    • As Pharmacy Networks Slim Down, Payers Have a Lot to Chew On, Suggest Experts
    • Plan Sponsors Continue to Weigh Narrow Networks vs. Disruption
    • BioScrip Settles FCA Case Tied to Exjade That Illustrates Risks of Narrow Networks
  • Medical Narrow Networks
    • 2012 Plan-Design Trends: More Cost Shifting, Narrower Networks
    • Non-Insurers Are Promoting Narrow-Network Plans to Large Employers
    • Narrow-Network MA Products Gain in Ariz.; Health Net Has Newest
    • Provider Consolidation Prompts Plans to Develop Narrow Networks for Exchanges
    • Health Plans Are Giving Consumers What They Want: Narrow Networks, Lower Costs
    • Insurers, Providers Feel Each Other Out as Narrow Networks Become Priority
  • Narrow Networks on Exchanges
    • Ala. Blues CEO Expects to Compete With ACOs, Narrow Networks
    • Narrow Networks: HMO Redux or Effective Rate-Reducing Strategy?
    • Narrow Networks Dominate Exchanges, but Aren’t Always the Lowest-Priced Option
    • HHS Issues Proposal on Carriers’ Network Size for Public Exchanges
  • Regulation and Litigation of Narrow Networks
    • $3.8 Million Jury Award Against Anthem May Be Warning for Plans, Narrow Networks
    • Providers Turn to Courts, Regulators for Relief as Insurers Favor Narrower Networks
    • Provider Groups Ask CMS to Delay Doctor Terminations by MA Plans, Extend AEP
    • Judge’s Ruling Could Bar Mass Terminations of Physicians From MA Networks by United
    • Senate Committee Hearing Gets Calls for Limits on Narrow MA Provider Networks
  • Pharmacy Narrow Network Case Studies
    • Citing Waning Pharmacy Loyalty, Humana Extends Narrow Network to Private Sector
    • Express Scripts-Walgreens Dispute Widens Path for Narrow Networks
    • Resolution Leaves Walgreens on Outer Tier of Express Scripts’ New Network
    • Walmart Exec Offers Shopping Guide to Custom Networks
    • As Walgreens Re-enters Express Scripts’ Network, Drug Store Chains Play for Keeps
    • Costco PBM Reflects Retailers’ Narrow Network, Direct-to-Employer Growth Tactics
    • Narrow Network Trend Paves Way for MedImpact’s Shared Performance Model
  • Medical Narrow Network Case Studies
    • Los Angeles Selects Anthem Blue Cross Sans UCLA, Cedars-Sinai
    • Blues Increasingly Turn to Tiered Networks to Compete in Transparent 2014 Market
    • Mass. Blues Attracts 200,000-plus Members to Its Tiered Network Products
    • Tenn. Blues Focuses on ACOs, Narrow Networks, Medicare Plans
    • Maine Blues, MaineHealth Form ACO, ‘Narrow Network’ Product
    • Ga. Blues Focuses on Exchanges, Work With Primary Care Physicians
    • Blues Plans Offer Narrow Networks in Commercial Plans

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