Insurers look to specialty drugs, efficiency incentives to moderate ACA costs

As the Affordable Care Act continues to negatively impact insurers in Massachusetts, sometimes causing major financial hits, they're taking specific steps to regain financial stability, reported the Boston Business Journal.

Though many insurers posted strong first quarter financial reports this year, as FierceHealthPayer has reported, companies in Massachusetts saw multimillion operating losses on the heels of a tough year last year. In fact, Blue Cross Blue Shield of Massachusetts reported a loss of $118 million and the other two big statewide insurers didn't fare much better. 

This last quarter, the Massachusetts insurers blamed the cost of ACA-related taxes and fees, as they were front-loaded in the first quarter, as well as hefty price tags for specialty drugs.

But each Bay State payer is ready to start improving its bottom lines. For example, Blue Cross and Harvard Pilgrim Health Care are working to lower the cost of specialty drugs, which they found have significantly cut into their profits.

Both insurers have negotiated new prices with drug maker Gilead for its hepatitis C medications, Sovaldi and Harvoni. Insurers have been eager to strike a deal with pharmaceutical companies, especially considering the backlash that Sovaldi received last year after the company placed a $100,000-per-person price tag on the drug.

Blue Cross has also created incentives for its higher-cost members to more efficiently spend their healthcare dollars, the BBJ noted.

Meanwhile, Tufts Health Plan is focusing on growing its membership, including expanding operations to neighboring New Hampshire and Rhode Island, to boost its profits.

To learn more:
- read the Boston Business Journal article