Montana's Unique, Evolving Healthcare Landscape Favorable For Pharma

Point-of-Service Plans Grew 78 Percent during Last Census Period, According to a New Report from HealthLeaders-InterStudy

Nov 07, 2013, 10:20 ET from HealthLeaders-InterStudy

NASHVILLE, Tenn., Nov. 7, 2013 /PRNewswire/ -- HealthLeaders-InterStudy, the leading provider of managed care market intelligence, identifies the rising popularity of point-of-service (POS) plans as an opportunity for the pharmaceutical industry in its first-ever Montana Health Plan Analysis report. POS plans provide flexibility in states like Montana, where the bulk of the population is more rural and points of access to care are separated by large distances. Such plans are generally priced between the more restrictive HMO plans and PPO plans, which usually have broader provider networks and fewer restrictions. Unlike an HMO offering, the POS product does not prohibit self-referral to specialists—and it also offers an out-of-network option for a higher cost, though the out-of-network options are not as great as with a PPO.

HealthLeaders-InterStudy's newly released Montana Health Plan Analysis report finds that POS products increased their market share by 78 percent between January 2012 and January 2013. POS plans are now the third most popular plan model in Montana's commercial segment, capturing 18 percent of the commercial market. In contrast, PPO plans—still the most popular products in Montana—declined in market share by three percent during the same period. Overall commercial enrollment for Montana increased seven percent, indicating a healthy economic outlook for the state.

"The exponential growth of point-of-service, or POS, plans in Montana will allow pharmaceutical companies to take advantage of the freedom of choice and fewer restrictions associated with these plans. Montana's unique and evolving healthcare landscape will also offer some challenges for Pharma—for instance, the competition brought about by a growing economy will require a focus on pricing strategies in order to take advantage of the health insurance exchange," explains HealthLeaders-InterStudy Analyst Jacqueline Cavnar. "Montana has a federally-facilitated health insurance exchange with three participating carriers: Blue Cross and Blue Shield of Montana, PacificSource Health Plans, and Montana Health CO-OP. The state's benchmark plan for essential health benefits has a fairly generous drug formulary, which means that drug companies will face a favorable environment in this new sales channel."

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SOURCE HealthLeaders-InterStudy