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Payers Newbriefs

New service to determine eligibility at the pharmacy

eRx Network of Fort Worth, Texas, in conjunction with partner RxHub, has announced the availability of a service enabling pharmacists to immediately determine eligibility for patients whose pharmacy benefit coverage is unknown at the time of processing. The eRx Commercial E1 service provides eligibility information for 150 million customers.

Study reveals low rise in 2006 Medicaid spending

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Medicaid spending rose by only 2.8 percent in 2006, the lowest spending growth rate in more than a decade, a study released by the Kaiser Family Foundation indicates. Additionally, state tax revenues rose 3.7 percent, making 2006 the first fiscal year since 1998 in which state tax revenues surpassed Medicaid spending. Kaiser executive vice president Diane Rowland said improved economic conditions caused the low enrollment growth rate of 1.6 percent in 2006, resulting in lower spending rates for the program. “When the economy improves, it is natural for Medicaid spending and enrollment growth to subside because fewer people turn to the program for assistance,” Rowland said.

Integrated cards to offer health, financial records

Minneapolis-based UnitedHealth Group will offer integrated health cards to its enrollees in 2007. The cards, developed by Exante Financial Services, will provide access to health and financial information, such as eligibility verification and flexible spending accounts. Other features will include access to personal health records and an optional line of credit.

Medicare eyes prevention through new partnership

The Centers for Medicare and Medicaid Services has issued a solicitation to implement a health promotion and disease prevention program through the Medicare Senior Risk Reduction Demonstration. The demonstration will evaluate private sector risk reduction programs and determine whether they can be applied to Medicare. In the belief that prevention hinges on individual lifestyle choices, CMS has also begun providing increased information and support to beneficiaries. “We have made a commitment to modernize Medicare and increase prevention efforts to reduce the burden of chronic conditions, but we can only achieve this goal through a partnership with seniors,” said CMS Administrator Mark B. McClellan, MD.