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Update on Generic Dispensing Margins: Even Ahead of the CMS Final Rule, AWP is no Longer the Prevailing Medicaid Standard

HHS OIG* on August 30 published a survey of the benchmarks states use to determine ingredient-cost reimbursement for Medicaid prescriptions. Of the 43 states identifying their benchmarks, 30 are using the newer Average Acquisition Cost (AAC) reference; only 11 are

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SSR Health’s Hidden Pipeline Analysis: Relative Price and Value of pre-Phase III Pipelines

We believe pre-phase III (i.e. ‘hidden’) pipelines are misvalued for a very simple reason: they’re hidden. However because companies’ patenting behaviors around early projects are relatively consistent and complete, careful analysis of patent data gives us an opportunity to see

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Evidence of Rate Shock on the Individual HIEs: Weak at Best

In 8 of the 10 states for which we have useful data, today’s (2013) premiums for individual coverage are (after being inflated by 6 pct to account for 2013 – ’14 health cost growth) very much on par with 2014

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SSR Index of Current-Quarter Healthcare Demand Growth, Initial 3Q13 Estimate

[print_me] We expect 3.9% (nominal) y/y growth in US health services demand during 3Q13, the product of 2.4% growth in unit demand, and 1.5% price growth. Unit demand growth moved to 2.1% during 2Q13 – a sequential improvement of 60

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Medicaid HMOs: More Growth, Less Risk

Enrollment in Medicaid HMOs will grow immediately in 2014 as some states expand Medicaid eligibility under the Affordable Care Act (ACA). Growth continues for some time thereafter as: 1) other states join the expansion; 2) an increasing percentage of Medicaid

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Health Insurers’ Participation on the Health Insurance Exchanges; and, Current-Market Premium and MLR Patterns by State

Health insurance exchange (HIE) participation across the publicly-traded HMOs varies greatly – the only consistent pattern being that the publicly-traded names’ are selectively focused on states with less concentrated supply-sides (i.e. states lacking dominant underwriters) AET most of all, and

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Premium Inflation on the HIEs – Case Study of the California Individual Market

Gross of subsidies, and controlling for medical cost inflation, 2014 individual premiums for the cheapest plan option in the California market are substantially (average 63%) higher than for the cheapest option in the current market. We believe much of the

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SSR Index of Current-Quarter Healthcare Demand Growth, Final 2Q13 Estimate

 We expect 3.1% (nominal) y/y growth in US health services demand during 2Q13, the product of 1.6% growth in unit demand, and 1.4% price growth. Unit demand growth remains very slow; the projected 1.6% rate is essentially equal tothe inherent

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The Practical Relevance of the Employer Mandate Delay

At most, the employer mandate would produce a roughly 40 bp gain in total national health spending. In reality the effect is likely to be even smaller. Less well compensated employees at smaller firms may continue to refuse coverage, and/or

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The SSR Healthcare Quarterly, Inaugural Edition

We intend the Quarterly as a periodic publication that: Brings together in one place our most current work on the major themes affecting US-listed healthcare names, Synthesizes our best thinking into a model portfolio consisting of specific weightings for healthcare

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