The Rights Of Non-Participating Providers In A Managed Care World

Rights Of Non-Participants In A Managed Care World – Assignment of Benefits for out-of-network providers can be a minefield for providers, and insureds. Self funded health plans should carefully address these issues in their Plan Document, especially those plans that have left the managed care world entirely (Like Cost Plus Groups in Texas).

Editor’s Note: While Managed Care may be  alive and well, many payers  and  providers are questioning the value of continuing the scheme.

Humana Pharmacy Has New Offerings For Self Funded Employers

LOUISVILLE, Ky.—Humana Pharmacy Solutions has announced two new offerings for self-insured employers, the pharmacy benefits management unit of Humana Inc. announced in a statement Thursday.The new options include the Wal-Mart Rx Network, which directs employees to fill prescriptions at the international retailer; and the Rx4Value formulary, which swaps certain name brand drugs for generic. “This is all about predictability,” said William Fleming, president of Louisville, Ky.-based Humana Pharmacy Solutions. He added that by influencing where drugs are purchased and which drugs are purchased, the new offerings give employers a guarantee of what their prescription prices will be annually. The Wal-Mart-focused network averages 10% savings on annual prescription costs, while the formulary averages 15%. If employers choose to enact both plans, the average savings increases to 20%. The program is available to self-insured employers with a minimum of 500 employees. By early 2013, Humana plans to offer similar options to fully insured employers, said Mr. Fleming.For more information about the pharmacy benefits options, call 855-605-6383.