HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, reports that Maryland's PharmFlex, a basic pharmacy plan with less stringent mandates, will be available July 1, 2006. According to the latest issue of Mid-Atlantic Health Plan Analysis, the plan introduces a core pharmacy benefit that includes both brand-name and generic drugs, a deductible of $2,500 for individuals and $5,000 for families and coinsurance of 25 to 75 percent.
"Contrary to what some news headlines have suggested, PharmFlex does not 'slash' drug coverage, or force the 450,000 Marylanders participating in small business insurance to lose prescription drug benefits," said Jan Shuxteau, HealthLeaders-InterStudy analyst. "What it does do is eliminate the previous highly prescriptive core services that everyone was required to buy, whether it met their particular needs or not."
The stimulus for PharmFlex was a state regulation that required that the cheapest mandated small-business health plan not exceed 10 percent of the average wage in Maryland. Escalating healthcare costs pushed at this barrier, forcing regulators to come up with a core pharmacy benefit that could be extended with flexible additional benefits and pricing.
Large insurers and business associations are in favor of PharmFlex because it can be part of almost every pharmacy plan insurers sell in other insurance markets.
Other health plan news in Maryland, Washington D.C., and Virginia: CareFirst BlueCross Blue Shield has distributed some $1.4 million in bonuses to 82 physicians in Maryland, Virginia and the District of Columbia who are participating in a pay-for-performance program developed by the Bridges to Excellence organization.
Maryland was the first state in the nation to approve a labor union supported "Wal-Mart Law," requiring the country's largest retailer to pay more into employee healthcare benefits.
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