Published Online: February 27, 2014
Katie SullivanHealth Insurance Exchanges: Challenges and Opportunities for Pharma
Dennis M. Falci, MBA, director, Sanofi-Aventis SA, says it’s no secret—Health Insurance Exchanges (HIEs) are a hot topic in health news.
HIEs are mandated as part of the Affordable Care Act (ACA), providing coverage to nearly 44 million people in the United States. Likening the exchanges to consumer tools such as Expedia, Mr Falci says insurance marketplaces function as a “one stop shop for healthcare,” helping Americans to find health plans that “meet their needs and reflect their eligibility.”
Once consumers are logged on a HIE web portal, they can choose from a variety of health plans. Levels of coverage include:
The Current State of Our Nation's Public Exchange Programs and the Rise of Private Exchanges
In a panel discussion moderated by Neil Minkoff, MD, CEO of FountainHead HealthCare, panelists examined the current state of healthcare exchanges, both public and private. Panelists included Dennis Falci, MBA, director, US managed markets training, sales training and leadership development, Sanofi-Aventis SA; Thomas Kaye, director of consulting pharmacy, Prescription Formulary Exchange, LLC; and Sheri Sellmeyer, vice president, market analysis, HealthLeaders-InterStudy, a Decision Resources Group Company. They analyzed the current benefit models required by public exchanges, and the rising popularity of the private counterparts, offering a glimpse into the new healthcare marketplace now unfolding.
Catastrophic: For people under 30 who cannot find coverage that is less than 8% of their income
Bronze: Pays for 60% of benefit package
Silver: Pays for 70% of benefit package
Gold: Pays for 80% of benefit package
Platinum: Pays for 90% of benefit package (for medal plans, remaining amounts are paid by consumer) Read more here: http://bit.ly/1fWGxVP
One of the major topics of discussion was resistance to mandatory health coverage, particularly among younger Americans. Falci, drawing on his own experiences, surmised that many of those who are young and in good health do not want to "overinsure" themselves with insurance plans that cover services generally utilized by older participants, especially when those plans come with high deductibles. Similarly, high co-pays and costly treatments could sway people to voluntarily decline pharmaceuticals and could promote non-compliance. Read more here: http://bit.ly/1o8L5N5
Continuing conference coverage and exclusive interviews from The Managed Markets Summit are available here: http://www.ajmc.com/conferences/mms2014